• Supports Clinical Operations functions and acts as liaison between Members, Physicians, Delegates, Operational Business members and Member Service Coordinators • Performs review of service requests for completeness of information and collection of non-clinical data • Initiates call backs and correspondence to members and providers to coordinate and clarify benefits • Handles initial screening for pre-certification requests via calls or correspondence based on scripts and workflows • Assists members with finding providers, resolving problems and answering questions regarding services • Makes outbound calls to engage members in Case Management and to complete necessary health assessments • Educates members regarding preventive health activities and services • Review medical and administrative documentation for accuracy and compliance standards

• Coordinates care of individual clients with application to identified populations using assessment, care planning, implementations, coordination, monitoring and evaluation for cost effective and quality outcomes • Duties are performed virtually or face-to-face based on contractual requirements • Promotes the appropriate use of clinical and financial resources in order to improve the quality of care and member satisfaction • Assists with orientation and mentoring of new team members as appropriate • Provides care coordination to members with behavioral health conditions identified and assessed as requiring intensive interventions and oversight including multiple, clinical, social and community resources • Conducts in depth health risk assessment and/or comprehensive needs assessment which includes, but is not limited to psycho-social, physical, medical, behavioral, environmental, and financial parameters • Communicates and develops the care plan and serves as point of contact to ensure services are rendered appropriately • Implements, coordinates, and monitors strategies for members and families to improve health and quality of life outcomes • Develops, documents and implements plan which provides appropriate resources to address social, physical, mental, emotional, spiritual and supportive needs • Acts as an advocate for member`s care needs by identifying and addressing gaps in care • Performs ongoing monitoring of the plan of care to evaluate effectiveness • Measures the effectiveness of interventions as identified in the members care plan • Assesses and reviews plan of care regularly to identify gaps in care, trends to improve health and quality of life outcomes • Collects clinical path variance data that indicates potential areas for improvement of case and services provided • Works with members and the interdisciplinary care plan team to adjust plan of care, when necessary • Educates providers, supporting staff, members and families regarding care coordination role and health strategies with a focus on member-focused approach to care • Facilitates a team approach to the coordination and cost-effective delivery to quality care and services • Collaborates with the interdisciplinary care plan team which may include member, caregivers, member`s legal representative, physician, care providers, and ancillary support services to address care issues, specific member needs and disease processes whether, medical, behavioral, social, community based or long-term care services • Utilizes licensed care coordination staff as appropriate for complex cases • Provides assistance to members with questions and concerns regarding care, providers or delivery system • Maintains professional relationship with external stakeholders, such as inpatient, outpatient and community resources • Generates reports in accordance with care coordination goal.

• Supports care management activities and the teams assigned to members to ensure services are delivered by the healthcare providers and partners and continuity of care/member satisfaction is achieved. • Interacts with members by performing member outreach telephonically or through home-visits and documents the plan for care/services of activities. • Provides outreach to members via phone or home visits to engage members and discuss care plan/service plan including next steps, resources, questions or concerns related to recommended care, and ongoing education for the member throughout care/service, as appropriate. • Coordinates care activities based on the care plan/service plan and works with healthcare and community providers and partners, and members/caregivers to accommodate changes or progress, as needed. • Serves as support on various member and/or provider inquiries, requests, or concerns related to care plan/service plan. • Communicates with care managers, practitioners, and others as needed to facilitate member services and to ensure continuity of care/service. • May support performing service assessments/screenings for members and documenting the member’s care needs. • Supports documenting and maintaining member records in accordance with state and regulatory requirements and distribution to providers as needed. • Follows standards of practice and policies compliant with contractual requirements and regulatory guidelines and standards. • Ability to identify needs and make referrals to Care Manager, community based organizations, and Disease Manager. • Provide education on benefits and resources available. • Performs other duties as assigned. Complies with all policies and standards.

• Supports Adolescent & Young Adult Medicine clinic • Coordinates health maintenance care for various patients • Regular patient outreach via phone • Assists with panel management and data collection • Provides a range of medical assistant duties as needed • Updates health maintenance and performs daily outreach • Keeps referral log of patient communication • Follows up on empaneled patients that have recently discharged • Obtains medical records and proactively schedules appointments • Participates in process improvement cycles and implementation of new workflows