• The Case Manager will focus on empowering the members’ family to support optimal wellness while advocating for the necessary medical services across the health care continuum. • Works in a telephonic managed care setting combining strong clinical knowledge and critical thinking to facilitate a plan of care that will ensure quality medical care for the high-risk member population serviced by ProgenyHealth based on the CMSA national standards for case management practice. • Assesses the physical, functional, psychological, environmental, educational, and financial needs of members referred to the Case Management program. • Completes needs assessments for all members in CM and develops care plans individualized to the needs of each member as per ProgenyHealth policies and procedures. • Assigns risk stratification based on complexity of medical and social needs and determines ongoing frequency of calls to continually assess plan of care. • Monitors the care plan to ensure effective, appropriate provision of services and adequacy of benefits. • Interfaces with providers to assist with care coordination activities, which can include appointments, transportation, DME, etc. • Provides education to members regarding condition, treatment plan, benefits, services, and how to access needed care. • Monitors ongoing progress towards goal achievement and reassess changes in health status throughout continuum of care. • Provides referrals to appropriate community resources; facilitates access and communication when multiple services are involved; monitors activities to ensure that services are actually being delivered and meeting the needs of the member. • Participates in interdisciplinary and client rounds with pertinent health care team members to identify, clarify, and/or prevent risk, quality, or plan of care variances.