Evaluation of Members:
- Using care management tools and information/data review, conducts comprehensive evaluation of referred member’s needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member’s benefit plan and available internal and external programs/services.
- Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate.
- Coordinates and implements assigned care plan activities and monitors care plan progress.
Enhancement of Medical Appropriateness and Quality of Care:
- Using holistic approach consults with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review to achieve optimal outcomes.
- Identifies and escalates quality of care issues through established channels.
- Utilizes negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs.
- Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
- Provides coaching, information, and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
- Helps member actively and knowledgably participate with their provider in healthcare decision-making.
Monitoring, Evaluation and Documentation of Care:
- Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
· Create actionable insights using business drivers, competitive environment, trends and operating metrics and leverage these to impact Client decision making, forecast, supply operations, and sales optimization.
· Work cross functionally to develop sales forecasts using levers, assumptions, and checks.
· Report out on variances to forecast, including key drivers, insights, and accurate bridges between actuals and forecast.
· Create annual/ quarterly, weekly planning reviews and reports and perform ad-hoc business analysis as required.
· Ensure that forecasts are accurately recorded in planning systems, received, and understood by partner teams, and accurately represented throughout the business.
· Assess risks and contingencies to mitigate headwinds, analyze inventory and performance against plan, then drive solutions with cross-functional stakeholders (supply allocations decisions).
· Identify, attain, and evaluate data to assist and propose business decisions in assigned sales area from different sources.
· Coordinate across sales and operations functions to produce weekly updates, driving towards product targets and performance goals.
· Communicate efficiently and timely with cross functional stakeholders.
· Reconcile numbers of vs existing dashboards and spreadsheets.
· Ability to run analysis of large complex data sets.
· Strategic planning, sales support, and market research experience.
· Strong knowledge of the consumer electronics market.