The Outpatient Case Manager conducts initial assessments within designated timeframes on patients identified as having complex case management needs (assessment areas include clinical, behavioral, social, environment and financial) Collaborates effectively with integrated care team to establish an individualized plan of care for members The integrated care team includes physicians, case managers, referral coordinators, pharmacists, social workers, and other disease educators Develops interventions to assist the member in meeting short and long term plan of care goals Engage patient, family, and caregivers to assure that a well-coordinated treatment plan is established Prioritize care needs, set goals and develop an initial plan of care that also addresses gaps and/or barriers to care and uses evidence-based practice as the foundation Make outbound calls to assess member health status, identify gaps or barriers in treatment plans Provide member education to assist with self- management goals Make referrals to outside sources Educate members on disease process or acute condition Coordinates and attends member visits with PCP and specialists as needed in special circumstances On a limited bases, a physical assessment may include taking of blood pressure, heart rate, respiratory assessment: Rate, effort, pulse oximetry, peripheral circulation and skin checks on exposed skin, foot checks for edema and skin integrity, home safety evaluation Seeks ways to improve job efficiency and makes appropriate suggestions following the appropriate chain of command Performs all duties for internal and external customers in a professional and responsible manner having fewer than two complaints per year Enters timely and accurate data into designated care management applications and maintains audit scores of 90% or better on a quarterly basis Adheres to organizational and departmental policies and procedures Takes on-call assignment as directed Maintains current knowledge of health plan benefits and provider network including inclusions and exclusions in contract terms With the assistance of the Managed Care/UM teams, guides physicians in their awareness of preferred contracts and providers and facilities Attends educational offering to keep abreast of change and comply with licensing requirements and assists in the growth and development of associates by sharing knowledge with others Participates in the development of appropriate QI processes, establishing and monitoring indicators Perform comprehensive assessments and document findings in a concise/comprehensive manner that is compliant with documentation requirements and Center for Medicare and Medicaid Services (CMS) regulations