Job Description:

Provides operational support and transition duties, as assigned, for longitudinal care management services for identified highest risk (complex) Intermountain patients. Provides extraordinary and value based care management. Works collaboratively with the care management team, patients, family caregivers, significant others, healthcare providers, payers, community-based providers, and other involved parties to provide effective, efficient, and patient-centered care management services.

Scope

Responsible for referral management of cases, care management pre-screening, patient scheduling, patient consultation, transition management, and other duties as assigned, and in accordance with Intermountain Healthcare's policies, procedures, guidelines, and professional licensure, to facilitate effective and efficient operations of the Community Care Management (CCM) team. The Community Care Management (CCM scope of services includes: utilization management (UM), transition planning (TP = high risk care coordination and discharge planning), and social work (SW) services. providing support to a defined patient population in accordance with Intermountain Healthcare?s policies, procedures, guidelines, and professional licensure.



Job Essentials

Understands, practices, and promotes the philosophy and guiding principles of Integrated Care Management. Develops relationships and collaborates with case/care management staff in episodic settings and across the continuum to promote process integration, seamless transitions from one case/care management program to another, continuity of care, and avoid duplicative care management services/process.
Referral Management: Monitors pending and prioritized referrals for the CCM team. Maintains a record of the average daily caseload and workload.
Pre-Screening: Pre-screens new cases and assigns an appropriate primary planner based on the patient's primary needs.
Patient Consultation: Promptly contacts new patients by phone to introduce them to the CCM program, obtain verbal consent to participate, and schedules the initial assessment/evaluation.
Intervention: Responsible for patient follow-up calls, as assigned by the CCM/CSW, to re-enforce education, self-management, and other care planning actions needed.
Intervention: Collaborates, educates, communicates, and networks with healthcare providers across the continuum to ensure the patient?s care planning needs are met.
Intervention: Advocates on behalf of patient, communicating and collaborating with healthcare providers, payers, physicians, and community-based services, where appropriate, to assist in establish an appropriate and integrated care plan for each patient.
Intervention: Promotes mental health integration by collaboration with mental health/behavioral health providers.
Intervention: Responsible for designated transition management duties to ensure an effective transition of care from one healthcare setting to another. Actively participates in system and regional process improvement initiatives to improve transitions of care.
Clerical/Support: Establishes and maintains current community-based services and provider resource lists.
Clerical/Support: Promptly and accurately performs duties, as assigned, to facilitate effective and efficient day-to-day operations and communication. Promptly escalates concerns to appropriate chain of command.
Clerical/Support: Effectively and efficiently supports interdisciplinary care conferences, using collaborative practice models that promote interdisciplinary care planning and teamwork.
Completes timely and accurate documentation in the medical record using knowledge of documentation standards for the department to facilitate communication with team members. Documentation is done in compliance with all clinical guidelines and billing/reimbursement standards.
Organizes and prioritizes daily work by assessing new, current, and discharging patient needs in area(s) of responsibility.
Ensure that productivity standards and expectations are met.



Minimum Qualifications

Three years of experience in patient care, care management, transition/discharge planning, medical assistance, healthcare coaching, or patient care coordination
- and -
Certification, Associate Degree, or Bachelor's degree in a healthcare field
- and -
Must have excellent interpersonal and communication skills.
- and -
Ability to adapt quickly as needs arise.
- and -
Knowledge of available health resources.

Preferred Qualifications

Bachelor's degree from an accredited institution.

Discharge/transition planning, healthcare coach, health advocate, or medical assistant experience.

Physical Requirements:

Lifting, twisting, standing, seeing, manual dexterity, speaking, sitting.

Location:

McKay-Dee Hospital

Work City:

Ogden

Work State:

Utah

Scheduled Weekly Hours:

40

The hourly range for this position is listed below. Actual hourly rate dependent upon experience.

$19.42 - $29.55

We care about your well-being – mind, body, and spirit – which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged. Learn more about our comprehensive benefits package and our commitment to diversity, equity, and inclusion .