Professional Management Enterprises (PME)

Clinical Specialist

• Execute case management activities, including telephonic member screening, care planning, care plan implementation, service coordination, monitoring and follow-up, reassessment, case conferencing, crisis intervention, and case closure
• Provide non-clinical support to the medical management or operations area
• Review case records and gather clinical data to determine the proper department or area for case assignment
• Receive inbound member case management calls and triage member needs via screening
• Provide community and other resources to members
• Make appropriate member referrals to clinical case managers
• Return voicemail calls received on the case management line
• Monitor and manage the case management inbound phone queue
• Provide information regarding in-network providers or general program information
• Assist with complex cases and act as a liaison between Case Management and other internal departments
• Maintain and update tracking databases
• Prepare reports and document all actions
• Exclude utilization management review activities and other clinical roles requiring interpretation of clinical information

Medical Management Specialist – Non-Clinical