Job Role Summary: This role involves providing health and wellness coaching, case management services, and analysis. The system will monitor cases and claims, analyze biometric and health risk assessment data, organize disease management programs, and proactively interact with members, physicians, and other providers. Oversee the development, implementation, and management of an integrated medical benefit program including case management and health/disease management. Establish a system for coordinating the caseload patient's care throughout the continuum of care. Use standard tools, databases, and methodologies to support the health benefit program and provide leadership in managing cases, events, and diseases that are determined to be targeted priorities by Senior Management of contracted employers. Interact with providers and plan members in case management medical activities to provide the most efficient and effective service. Identify targeted chronic diseases/high risk individuals (with vendor support) and develop programs to reduce the financial and health risks, using internal hospital programs/services whenever possible. Monitor and evaluate the effects of case management on the patient population. Create outcomes-management focus by interdisciplinary analysis of specific clinical, financial, and satisfaction elements for the patient population. Assist in the analysis of demographics, utilization, and reimbursement. Prepare cost analysis and other reports to determine the reasonableness of claim/cost data and utilization rates. Make recommendations based on data analysis for benefit structure, pharmacy formulary, deductibles, co-pays, out-of-pocket, etc. to contracted employer groups. Maintain consistent attendance, punctuality, and personal appearance in accordance with organizational attendance and dress code policies. Uphold organizational values by treating others with respect, keeping commitments, and working ethically and with integrity. Attend meetings as required and participate in team activities. Exhibit confidence, motivate, and inspire others. Establish and maintain effective working relationships with team members, patients, and the public by demonstrating the ability to communicate verbally and in writing while responding clearly and effectively. Use time efficiently, plan for additional resources, set goals and objectives, and work in an organized manner. Demonstrate safety practices and maintain a safe environment for patients, visitors, and fellow team members by following established safety and infection control standards.