Job Description

Description:

Responsible for performing care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum.

Performs duties telephonically for discharge planning.

Primary duties may include, but are not limited to:

- Ensures member access to services appropriate to their health needs.

- Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment.

- Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements.

- Coordinates internal and external resources to meet identified needs.

- Monitors and evaluates effectiveness of the care management plan and modifies as necessary.

- Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans.

- Negotiates rates of reimbursement, as applicable. Assists in problem solving with providers, claims or service issues.

Additional Skills & Qualifications:

Team: Medicaid Georgia Market

Case Management experience strongly preferred

About Actalent:

Actalent connects passion with purpose. Our scalable talent solutions and services capabilities drive value and results and provide the expertise to help our customers achieve more. Every day, our experts around the globe are making an impact. We\'re supporting critical initiatives in engineering and sciences that advance how companies serve the world. Actalent promotes consultant care and engagement through experiences that enable continuous development. Our people are the difference. Actalent is an operating company of Allegis Group, the global leader in talent solutions.

The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

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