Care Management Specialist

Regular
Exempt

GENERAL DESCRIPTION:
Carries out nursing functions in performing care management process, organizational determinations, and transitional care, including, but not limited to, health assessments, biopsychosocial needs assessment, and barriers for policyholders with medical conditions to develop a comprehensive and customized care plan. Effectively coordinates the services necessary to maintain policyholders’ optimal level of health and facilitate access to services according to established requirements and timelines.
ESSENTIAL FUNCTIONS:
•Evaluates the criteria for admission to Complex Care Management Programs and Initiatives.
•Evaluates the policyholder’s condition to identify individual needs through a Health Risk Assessment.
•Establishes a comprehensive and individualized care plan with specific goals for each policyholder enrolled in the Care Management program using their judgment and the clinical guidelines adopted by the Company.
•Proactively identifies problems and barriers that may affect the policyholder’s care,



establishing achievable goals and short- or long-term case management strategies and interventions.
•Guides the patient and family during the phase of acceptance and adaptation to chronic medical conditions that may result from them and provides appropriate follow-up.
•Documents the progress of the policyholder’s condition and all actions taken using the electronic app for documentation within the care plan and the electronic file, according to the policies and procedures established in the unit.
•Keeps effective communication about the policyholder’s condition and treatment with the physician, the service provider, and even the policyholder to evaluate their progress, guarantee integration in physical and mental health care, promote the policyholder’s self-care, and clarify any situation related to the clinical services they receive.
•Evaluates the effectiveness of the policyholder’s treatment. Takes part

📌 Care Management Specialist (San Juan)
🏢 MCS Healthcare Holdings, LLC (MCS)
📍 San Juan