Professional Management Enterprises

The specialist provides non-clinical support for medical management operations calls, handling complex file reviews and inquiries from members and providers. Primary duties involve gathering clinical information, conducting initial file reviews, updating tracking databases, and responding to requests within scope.

The Case Manager will use clinical judgment to assess member needs, develop care plans to meet identified goals, and monitor the effectiveness of these plans. Responsibilities also include supporting member access to quality care and coordinating with internal and external resources and providers.