• Develops, assesses, and facilitates complex care management activities for primarily physical needs members • Evaluates the needs of the member, barriers to accessing the appropriate care • Develops ongoing care plans / service plans • Identifies problems/barriers to care • Provides ongoing follow up and monitoring of member status • Collaborates with member, caregivers, and appropriate providers to revise or update care plan as necessary • Provides resource support to members and care managers for local resources • Facilitates care management and collaborates with appropriate providers or specialists • Collects, documents, and maintains all member information and care management activities • Provides and/or facilitates education to members and their families/caregivers on various processes