• manage an individual caseload using the case management process • authorization of services and review of treatment plans • ongoing communication with all members of the health care team • review all medical data for case management plan • assess problems and determine goals and actions for patient needs • make contact with payer office to understand benefit constraints • negotiate with providers to maximize medical benefits available to the patient

• Manage an individual caseload using the case management process • Authorization of services • Review of treatment plans for medical necessity • Ongoing communication with all members of the health care team • Review all medical data to establish, update and maintain accountability for a case management plan • Assess problems and determine goals and actions designed to meet patient needs • Work in conjunction with the Case Management Assistant to manage case management files • Maintain case in computer system documenting case actions for each patient

• assists the RN Case Manager in performing necessary functions using the case management process • authorization of services • review of treatment plans for medical necessity • ongoing communication with all members of the health care team • operates under the direct supervision of the RN Case Manager • review all medical data to update a case management plan • make contact with the payer office to understand benefit constraints • proceed with contacting medical care providers to verify medical necessity • make care arrangements for quality patient care • negotiate with providers to maximize medical benefits available to the patient • maintain case in computer system documenting case actions

• The Chronic Condition Case Manager will have direct responsibility for managing an individual caseload using Complex and Chronic Condition Management constructs. • This individual is expected to accurately service and satisfy customers by responding to customer inquiries, communicate benefit and healthcare questions/answers. • Collect and document patient information to facilitate the initial assessment and formulation of an initial plan of care. • Continuously gather, update and review information to include (but not limited to) collecting medical records, history, assessment information. • Guide, coach and encourage the patient in following the plan of care. • Instruct the participant regarding both short and long-term goals and offer guidance as to how to meet those goals. • Document actions taken and interventions provided throughout the process. • Collaborate with providers, payers, and participants to ensure that the participant has access to appropriate resources. • Maintain documentation in the computer system. • Complete all aspects of case in the computer. • Prepare timely reports to the payer to summarize case actions, the results of those actions, and the continuing disease management plan. • Maintain billing as appropriate in computer system.