Job Description
About the position
Under the direct supervision of the Population Health Manager, this person works collaboratively with Providers, clinical support staff and other health care professionals to provide a medical home and optimize care for patients and providers in a Team Based Approach to Care.
The Acute Care Manger (ACM) is an integral part of the team and is responsible for the day to day prioritization of interventions on a list of required services for patients on a provider’s panels.
The work of the ACM will be driven by established quality benchmarks and clinical practices including, but not limited to, Uniform Data System (UDS), Patient Center Medial Home (PCMH) and Healthcare Effectiveness Data and Information Set (HEDIS).
- Responsibilities
- Conduct a pre-visit panel assessment to pro-actively drive care team communication related to required service delivery during scheduled encounters. (i.e. huddles, pre-visit planning, recalls, follow-ups).
- Maintain knowledge of daily patient schedule, to assess availability and triage work-ins.
- Conduct Triage (telephonic during normal business hours) and provide education utilizing the organization’s evidence based select criteria for education and triage within scope of practice.
- Coordinate quality improvement strategies with oversight from the Practice Manager and the assigned QI Champion as directed by the Kintegra Health QI Department working with QI Champions.
- Maintain detailed knowledge of role of providers, support staff, and EMR documentation standards to understand and analyze clinical quality reports
- Facilitate new patient education related to Medical Home concept, Patient Portal, Kintegra Health ancillary services as well as the Team Based Approach to Care.
- Act as a liaison between patients, clinical teams, clinical operations, patient services, customer care departments, etc.
- Assist with providing Med Adherence Support working with Kintegra Pharmacy Team.
- Completion of Health Risk Assessments.
- Provide Chronic Care Management Services, if indicated, by outreaching to patients telephonically to create care plans to support their disease management goals.
- Clearly and effectively communicates and coordinates with all providers, interdisciplinary team members, community resources, and contracted partners
- Documents clearly, completely and concisely in electronic medical record related to all care management activities.
- Attend one site departmental meetings
- Willingly perform other duties as assigned.
- Requirements
- Excellent verbal communication skills.
- Must be able to work with changing priorities.
- Requires excellent organizational, problem solving and critical thinking skills.
- Proficiency in Microsoft Office Suite.
- Aptitude and understanding of a QI process methodology and proficiency in EMR documentation and electronic chart review
- Minimum of (3) three years of experience in a public health or an ambulatory care setting.
- Licensed Practical Nurse (LPN)
- Unrestricted license in the state of North Carolina (if applicable); Current BLS certification.
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