Case Manager

Position

Case Manager

Responsible To

Case Manager Lead

Department

Health Education

Summary

The Case Manager provides patient centered outreach to ensure patients receives key clinical services to improve patient health outcomes. The Case Manager will support, guide and educate patients in accessing services. Additionally, the Case Manager is responsible for providing interdepartmental support by conducting on-going patient outreach and quality improvement activities that will encompass managing quality measures for Healthcare Effectiveness Data, Information Set (HEDIS), Health Resource & Service Administration (HRSA) and Centers of Medicare (CMS) Star Rating Program. The duties and responsibilities will apply to all Independent Practice Associations (IPA), grants, and health plans for which Camarena Health contracts. The Case Manager reports to the Lead Case Manager.

Expectations

• Arrives on time and adheres to set schedule.
• Effectively manages patients by ensuring that they are connecting patient with health center resources.
• Effective and sensitive in addressing patients’ needs in telephone or face to face.
• Collects and records data accurately.
• Maintains open communication with supervisor and all staff, acting as a liaison between medical staff and patients.
• Use of professionalism and best efforts in your position.
  
  

DUTIES and RESPONSIBILITES

1.0 Focus On Health Maintenance Of Camarena Health Patients

1.1. Works directly with IPA/health plans to identify gaps in care and strategies on care gap closure

1.2. Understands the principals of HEDIS, CMS Star Rating Program, HRSA and National Committee of Quality Assurance (NCQA)

1.3. Generates reports from health plans’ portals and current system applications

1.4. Makes outbound calls to patients to remind them of needed preventative screenings with the goal to identify if any screenings have already been performed and, if they have not been completed, to assist the patient in any way possible to complete the screening.

1.5. Obtains records from outside providers to satisfy gaps.

1.6. Provides assistance in obtaining services (i.e., provide reminders, make appointments, arrange transportation etc.) to avoid delays in treatment and improve patient health outcomes.

1.7. Develops and distributes educational information to patients to assist in the understanding of preventive health in accordance with quality measure outreach plan (mailings, social media, patient engagement tools, automated calls, etc.)

1.8. Assists in the development and standardization of documentation and manages the data flow process to complete HEDIS documentation

1.9. Evaluates ER utilization dashboards from IPA/Health plans and conducts outreach to engage patient on the benefits of preventive maintenance.

1.10. Works collaboratively with hospitals on Admissions and follow up to reduce hospital readmissions

1.11. Work collaboratively with appointment staff to schedule new patients for Initial Health Assessment

1.12. Identifies chronic conditions which are high cost and actively communicates with provider to optimize care

1.13. Documents patient participation and outreach activities in accordance with HIPAA documentation standards.

1.14. Identifies/initiates standing order and completes according to protocol.

1.15. Maintains incentive database to track patient’s compliance.

1.16. Utilizes computer to access and obtain labs, appointments, patient information, medication, and clinical notes when necessary.

1.17. Focuses on patient support by actively listening to patient issues and requests, recording pertinent information accurately and remains responsive at all times.

1.18. Assist patients with referral processes

2.0 Focus On Corporate Expectations/Standards

2.1. Maintains cleanliness and order of work area, equipment and supplies.

Promotes mutual respect and allows others to get their work done by limiting non- work-related interruptions.

2.2. Functions as part of Camarena Health’s quality improvement group by actively ensuring that the quality of information collected is correct.

2.3. Ensures development of program by actively participating in the creation and revision of case management protocols as necessary

2.4. Maintains direct communication with site Managers, providing updates on

operational issues, process improvement suggestions, and other concerns.

2.5. Attends and actively participates in all meetings (e.g., team meetings, department meetings, program meetings, case management meetings, employee staff meetings) and other activities as required or assigned.

2.6. Attends workshops/seminars as necessary to increase skills and knowledge to provide effective support.

2.7. Supports the overall work of the health center by working flexible or extended hours when necessary to ensure consistent patient access and quality of service.

2.8. Demonstrates awareness of, and compliance with, organizational mission and objective of Camarena Health to provide health care access and support services for all members of the community.

2.9. Other work-related duties as assigned by supervisor; duties and responsibilities may be added, deleted, or changed at any time at the discretion of management, formally or informally either verbally or in writing.

2.10. Maintains confidentiality and respect for information regarding patients and other team members; abides by Camarena Health Rules of Confidentiality

Minimum Requirements

Education:

• High School Diploma
• Certification as Medical Assistant or prior experience
• CCMA Certification or equivalent (Has to be obtained within 6 months of your date of hire)
• Good interpersonal and communication skills
• Flexible scheduling required
  
  

Prior Experience

• Previous experience in a health care setting as a Medical Assistant or Case Manager
• Familiarity with primary care outpatient clinic procedure
  
  

Skills

• Bilingual (English / Spanish)
• Effective oral and written skills;
• General medical terminology and standard abbreviations used in medical notations
• Understanding of basic patient chart procedures and medical record systems;
• Intermediate to expert computer user experience;
• Telephone courtesy; customer-service oriented;
• Modern office practices and procedures including email;
• Attention to detail and excellent follow-through on work tasks:
• Demonstrates good problem-solving skills;
• Able to track multiple tasks and complete promptly and accurately;
• Able to quickly build and maintain rapport with patients and providers of differing backgrounds; team player.
• Knowledge of laboratory, examination, diagnostic and treatment room procedures
• Knowledge of patient education principle (health teaching) to develop self-care program
• Ability to administer medications and injections
• Ability to take vital signs and detect complications in patients
  
  

Requirements

Physical Requirements:

• Must be able to move up to 20 pounds and push up to 50 pounds (on wheels).
• Must be able to hear staff on the phone and those who are served in-person, and speak clearly in order to communicate information to patients and staff.
• Must be able to have vision that is adequate to read memos, computer screens, and personnel forms, clinical and administrative documents.
• Must have high manual dexterity.
• Must be able to reach above shoulder level to work, must be able to bend, squat, sit, stand, stoop, crouch, reach, kneel, twist, and turn.