ACO Case Manager

The ACO Case Managers will play a vital role in the clinical, financial and education of patients and will ensure these aspects are all considered simultaneously throughout the continuum of care. ACO Case managers will ensure the patient receives the right services at the right level of care and will assist the patient in navigating their own care at an optimum level.

• ·         Communicates the ACO Care Coordination process to Beneficiary/family/physicians and other Care Coordination team members explaining beneficiary’s right to refuse care coordination (opt-out) and accept (opt-in) as desired and the benefits of the program to the Beneficiary/family/physicians at no cost to the Beneficiary.
• ·         Demonstrates the ability to follow through with requests, sharing of critical information, and getting back to individuals in a timely manner.
• ·         Functions as liaison between administration, Beneficiaries, physicians and other healthcare providers.
• ·         Interacts professionally with Beneficiary/family/physicians and involves Beneficiary/family/physicians in formation of the plan of care.
• ·         Develops an outcome-based plan of care, based on the Beneficiary’s input and assessed Beneficiary needs. Implements and evaluates the plan of care as often as needed as evidenced by documentation in the Beneficiary’s case file with clear and concise Beneficiary focused goals and outcomes.
• ·         Documents Beneficiary assessment and reassessment, Beneficiary care plans, and other pertinent information completed in the Beneficiary’s medical record utilizing critical thinking skills and in accordance with the FOCUS Charting methodology, nursing standards, and company policies and procedures.
• ·         Educates the Beneficiary/caregiver on the transition process and how to reduce unplanned transitions of care.
• ·         Identifies and addresses psycho-social needs of the beneficiary’s, family and facilitates consultations with Social Worker, as necessary.
• ·         Responsible for the coordination and facilitation of Beneficiary and family conferences as determined by assessment of Beneficiary’s needs telephonically.
• ·         Responsible for the coordination of post-discharge clinic appointments, medication reconciliation, PCP and SPC visits.
• ·         Responsible for the identifying beneficiaries that are appropriate for hospice conversion or Palliative care, and assist the beneficiaries and/or their families in accomplishing this process if requested.
• ·         Distribution of work: Daily production will vary from day to day. All assigned work must be completed by the end of business day in order to maintain customer service to High Risk patients.
• ·         Protects privacy for both beneficiaries and employees; ensuring all personal health information is kept confidential-complies with HIPPA regulations.
• ·         Other duties as assigned.

Qualifications

• ·         Graduate from an accredited Registered Nursing Program or Licensed Vocational Nursing Program.
• ·         Current CA RN, or LVN license, valid CA Driver’s license.
• ·         3 years acute care or care management experience.
• ·         Typing 40 words per minutes with accuracy.
• ·         Knowledge of computers, faxes, printers and all other office equipment.
• ·         Knowledgeable in MS Office Programs (i.e., Word, Excel, Outlook, Access and PowerPoint)
• ·         Possible on call duties as assigned.