Responsibilities

As a member of the Population Health Management (PHM) Team, the Outpatient Case Manager works with members, providers and caregivers to provide intensive, comprehensive case management and increase efficient utilization of services for patient with complex needs; identifies chronic, complex and or catastrophic cases through the case management process and or referrals and initiates intensive case management according to program guidelines. This role will utilize multiple disciplines as CM to focus on various different patient populations.
The goal of the PHM OP Case Manager is to effectively manage patients on an outpatient basis and during episodes of acute hospitalizations (in conjunction with their inpatient counterparts) to assure the appropriate level-of-care is provided, optimize safe transition to home or the next level of care, prevent inpatient re-admissions and ensure that the patients’ medical, environmental and psychosocial needs are met over the continuum of care. The Case Manager acts as an advocate for members and their families linking them to other appropriate disciplines on the care team to facilitate patient/family education for better self-management, navigation of the health care system, and to identify community resources as necessary.

The PHM OP Case Manager:
- Will be embedded and connect with patients face to face or on the phone
- Telephonic only
Both types will coordinate with other members of the PHM team or multidisciplinary care team to adequately coordinate and manage patient needs
Telephonic Case Management Focus:
Will have a role that primarily the same as the outpatient PHM OP case manager, but will follow patient telephonically only and will support more multiple physician practices or patient populations based on patient volumes.

Qualifications