The Care Manager must have a demonstrated proficiency in the ambulatory care manager duties described below:
a) Care manager makes an outreach call within 24 hours of urgent referrals, 72 hours for routine referrals and initiates and or completes ACM assessment and care-plan.
b) Complete assessment for current/past medical conditions with dates of diagnosis, psychosocial issues, medications, ADL's, pain assessment, assess for advance directive/POLST/DPOA, cultural/linguistic needs, mental status, depression screening, available benefits, member/caregiver goals, degree of involvement, and resources; barriers to treatment. Accurately document above assessment in CS-Link.
c) Consults with assigned Primary Care Physicians, as needed, to discuss status of new referrals and to discuss the status/treatment plan of patients enrolled in ACM.
d) Ensure managed care referrals are processed, per NCQA Guidelines, and appropriately documented in Access Express.
e) Process all appropriate services based upon covered benefits, health plan or Milliman Care Guidelines, or medical necessity:
f) Monitoring of continued appropriateness of the services rendered i.e. home health, DME, outpatient therapy.
g) Work collaboratively with social workers re: alternate housing or placement and notification of transfer SNF of ALF. Transitions of Care are accurately and consistently documented.
h) Transitions of Care Hand-Off, to assigned ISP CM, when ACM patients are admitted to CSMC. o Ambulatory case managers will contact the patients telephonically, within 48 hours, post-discharge.
i) Ambulatory Care Manager will meet patient, at physician appointments, as necessary, to build rapport with high risk individuals, or, when additional support is required.
j) Refer high risk patients to Supportive Care Services Program, and NP House Call Programs, as appropriate.
k) Coordinate referrals and secure appointment with various CSMNS Disease Management programs such as Anticoagulation Clinic, Asthma, Diabetes, Hepatitis C, Smoking Cessation, Cardiovascular Risk, as appropriate.
In addition, the care manager is expected to be able to:
1) Pass documentation audits 2) Monitor new patient referrals 3) Monitor the hospitalizations of the patients enrolled into ACM and maintain logs
Providing healthcare for more than 100 years, Cedars-Sinai has evolved into one of the most dynamic and highly renowned medical centers in the world. Along with caring for patients, Cedars-Sinai is a hub for biomedical research and a training center for future physicians and other healthcare professionals. This attracts exceptional talent to Cedars-Sinai, including world-renowned physician-scientists who seek a place where they can both conduct research and see patients--the ideal formula for discovery and its translation into cures. Our patients benefit from access to doctors at the top of their fields, and our researchers have an ideal community in which to study the impact of healthcare challenges, and reflect that knowledge in their research. The greater Los Angeles area in which Cedars-Sinai resides possesses unparalleled cultural and ethnic diversity which offers outstanding opportunities for translational and clinical research... and a dynamic environment for medical education.Although community based, Cedars-Sinai is a major teaching hospital affiliated with the David Geffen School of Medicine at the University of California, Los Angeles (UCLA). Cedars-Sinai has highly competitive graduate medical education programs in more than 50 specialty and subspecialty areas, a graduate program in biomedical sciences and translational medicine, a clinical scholars program directed towards junior physicians with aspirations to become clinical scientists, and post graduate training opportunities.There are more than 250 full-time faculty members at Cedars-Sinai. The voluntary medical staff, comprised of more than 2,200 specialty board-certified or board-qualified physicians, represent all of the specialties and subspecialties and collaborate with full-time medical staff in the teaching responsibilities of the graduate medical education programs.