The Case Manager is a key member of the interdisciplinary care team (ICT).
They use a collaborative process of assessment, planning, coordinating, and monitoring to meet members' health and social needs.
They act as a liaison between Members, their Responsible Parties, the Advance Plan Provider/PCP, and key stakeholders.
Curana Health aims to radically improve the health, happiness, and dignity of older adults. They are a national leader in value-based care, serving 200,000+ seniors in 1,500+ communities across 32 states with a team of more than 1,000 clinicians alongside care coordinators, analysts, operators, and professionals from all backgrounds.
Assists in the maintenance of structures and processes which support improvement and patient safety.
Uses clinical knowledge in formal and informal consultation with individual staff, clinicians and managers, to address clinical quality and safety concerns.
Participates in clinical adverse event task groups.
Dartmouth Health is a nationally recognized Academic Medical Center set in the White Mountains of New Hampshire, stretching over New Hampshire and Vermont. They offer a rigorous, research-focused environment and are anchored by the academic Dartmouth Hitchcock Medical Center in Lebanon, NH.
Review medically complex claims, pre-authorization requests, appeals, and fraud/abuse referrals.
Assess payment determinations using clinical information and established guidelines.
Evaluate medical necessity, appropriateness, and reasonableness for coverage and reimbursement.
Broadway Ventures transforms challenges into opportunities with expert program management, cutting-edge technology, and innovative consulting solutions. As an 8(a), HUBZone, and Service-Disabled Veteran-Owned Small Business (SDVOSB), they empower government and private sector clients by delivering tailored solutions that drive operational success, sustainability, and growth.
Complete Comprehensive Health Evaluations (CHEs) to assess and manage comorbid conditions while addressing medical, social, emotional, and financial needs.
Manage CKD and ESKD patients, focusing on slowing disease progression, reducing costs, and preventing readmissions.
Lead the clinical team to ensure care coordination aligns with medical treatment plans and addresses both medical and psychosocial needs.
DaVita is a comprehensive kidney care provider focused on transforming care to improve the quality of life for patients globally. As of March 31, 2022, DaVita served 200,800 patients at 2,809 outpatient dialysis centers in the U.S.
Serve as the first line of support for residents and facility staff after-hours, providing direction and medical care over the phone.
Use Curana’s telephonic platform to take and place calls, coordinating care between facilities, hospitals, and clinics.
Deliver high-quality, cost-effective care to patients—addressing acute, chronic, and behavioral health needs in collaboration with physicians and specialty providers.
Curana Health is dedicated to radically improving the health, happiness, and dignity of older adults. They are a national leader in value-based care, serving 200,000+ seniors in 1,500+ communities across 32 states with a team of more than 1,000 clinicians.
Provide psychiatric evaluations, medication management, and ongoing care to the Medicaid population.
Focus fully on clinical care with administrative support for scheduling, insurance, and billing.
Shape practice culture and improve mental healthcare access for Medicaid members.
Third Space Therapy provides Medicaid-covered behavioral healthcare combining private practice independence with group support. They focus on expanding access to care and offer a supportive, autonomous environment for practitioners to shape the practice's culture and direction.
Provide case management to members including medical, social, psychological, physical, and spiritual needs.
Develop, implement, and monitor the care plan in conjunction with the PCP, caregivers, and other team members.
Help meet the member's needs.
Elderplan and HomeFirst are Medicare and Medicaid managed care health plans that are expanding services in response to patients' needs. At MJHS, they are a supportive community committed to excellence, respect, and providing high-quality, personalized health care services.
Collaborate with interdisciplinary team members to develop, implement, or evaluate treatment plans.
Conduct individual psychotherapy for those with chronic or acute mental disorders.
Prescribe psychotropic medications, including controlled substances, and educate patients on medication risks, benefits, and side effects.
Brave Health is dedicated to transforming lives by expanding access to compassionate, high-quality mental health care. As a community health-centered organization, they focus on making mental health care accessible and affordable, particularly for those receiving healthcare through Medicaid.