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Principal Duties and Responsibilities:

The following duties are typical for this position. These are not to be construed as exclusive or all-inclusive. Other duties may be required and assigned.

• As part of an interdisciplinary team (which also includes a RN Care Manager and the member and/or legal representative) conduct a comprehensive assessment of the member’s outcomes needs and risks; and conduct a reassessment as the member?s outcomes and/or condition changes.
• Develop coordinate monitor and evaluate the members? outcome-based member-centered plans considering cost and effectiveness in authorizing services and choosing providers.
• Implement risk mitigation strategies to promote the member?s health safety and independence while respecting the member?s rights.
• Coordinate and participate in home visits and care conferences involving the member their supports and providers to assess and reassess long-term care needs and coordinate appropriate interventions.
• Collaborate with the RNCM to coordinate acute and primary care services care transitions and related follow-up care.
• Coordinate care and benefits to ensure a comprehensive support approach as well as on-going access to federal and state programs.
• Create and maintain member records as required by the Department of Health Services (DHS) contract and LC policy.
• Educate members of their rights to appeal and grieve decisions and processes and facilitate the member’s participation in the appeal/grievance process.
• Current knowledge to ensure compliance with Federal and State regulations LCI policy and procedure and accepted professional standards.
• Maintain the confidentiality of member information and protected health information (PHI) as required by State and Federal regulations including the Health Insurance Portability and Accountability Act (HIPAA) of 1996.