Disease Management Program Coordinator LCSW PT-20 hours-Harbor City

4 weeks ago

Harbor City, United States Kaiser Permanente Full time
Job Summary:

Collaborates with Chief Physicians, staff physicians and managers/care providers from multiple disciplines/departments to manage the planning, development, implementation/ delivery and evaluation/improvement of a disease management program for at-risk patients in a behavioral healthcare population defined by a chronic psychiatric disease state or disorder such as, but not limited to, characterological disorders/conditions, depressive, anxiety and/or personality disorders, dual diagnosis, substance addiction, autism.

Essential Responsibilities:
  • Responsible for coordinating an integrated systematic care management process/ program based on clinical pathways, protocols and guidelines.
  • Such program directs the member/patient to appropriate and timely specialty diagnostic and treatment care services across the full continuum of care.
  • Provides comprehensive on-going care management that meets established standards/ benchmarks for efficiency, improved clinical outcomes, quality, resource utilization, cost effectiveness, evidence-based treatment plans and improves members quality of life and satisfaction.
  • In the program planning/development stage, acts as project manager to develop a strategic/business plan which meets access, cost, quality and member/patient satisfaction goals and needs.
  • Utilizes a multi-disciplinary team approach/process to develop and implement clinical pathways and care management interventions.
  • Identify and stratify at-risk patient populations.
  • Analyze practice patterns/variations.
  • Establish care/treatment benchmarks.
  • Design a disease care model for analyzing disease components and interventions which addresses all components of patient care including patient self-management, education/teaching, and stratified interventions based on illness severity and co-morbidities.
  • Pilot tests new and administers/communicates on-going program in conjunction with Chief Physicians and care providers/managers.
  • Manages disease-specific data collection, analysis, and reporting based on financial, clinical, utilization, cost, best practices, and baseline metrics.
  • Problem solves program issues and treatment variations.
  • Analyzes program outcomes actually achieved vs intended outcomes.
  • Monitors and resolves program compliance issues involving providers and patients.
  • Evaluates disease management program in terms of utilization review/resource issues such as treatment variances, goal achievement of interventions, effective interaction between all clinicians/providers, appropriateness of program care model, quality improvement and patient/member satisfaction.
  • Conducts analyses related to protocol/treatment plan compliance as well as clinical, quality, communication, financial/cost outcomes and makes recommendations for program revisions.
  • Monitors, evaluates and improves patient access provided by care managers via telephone and other means in order to improve patient self-care/management, compliance and participation in care processes.
  • Acts as organization liaison with relevant community agencies, organizations and task forces.

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