• Develops a proactive plan of care to address identified issues to enhance the short and long-term outcomes as well as opportunities to enhance a member’s overall wellness. • Uses clinical tools and information/data review to conduct an evaluation of member's needs and benefits. • Applies clinical judgment to incorporate strategies designed to reduce risk factors and barriers and address complex health and social indicators which impact care planning. • Conducts assessments that consider information from various sources, such as claims, to address all conditions including co-morbid and multiple diagnoses that impact functionality. • Uses a holistic approach to assess the need for a referral to clinical resources and other interdisciplinary team members. • Collaborates with supervisor and other key stakeholders in the member’s healthcare in overcoming barriers in meeting goals and objectives, presents cases at interdisciplinary case conferences. • Utilizes case management processes in compliance with regulatory and company policies and procedures. • Utilizes motivational interviewing skills to ensure maximum member engagement and discern their health status and health needs based on key questions and conversation. • Administers the care coordination plan to assess patient needs and ensure seamless transitions between different care settings. • Analyzes complex patient data from medical history, diagnostic test results, and treatment plans, to understand the current health status of the patient. • Applies in-depth knowledge of case management to organize patient files in an orderly manner for easy retrieval. • Communicates through internal platforms to securely exchange messages, conduct video conferences, share files, and collaborate on patient care plans. • Conducts routine utilization reviews to ensure patients have access to appropriate cost-effective care. • Configures the case management system to organize cases dealing with disease management and utilization review; tracks patient progress and manages specific conditions. • Coordinates analytics projects to enable case managers to analyze data and generate reports on key performance health indicators. • Designs complex processes to coordinate discharge planning in a safe and timely transition from the hospital to home. • Develops resource management to help case managers optimize healthcare with community resources.