Patient Care Manager
3 days ago
The Patient Care Manager will oversee a team of healthcare professionals providing in-home health assessments and care, while managing daily clinical operations. This role involves ensuring high-quality patient care, managing staff, and overseeing clinical performance metrics. The Patient Care Manager will collaborate with medical professionals and management to develop and implement patient care protocols, ensure compliance with healthcare regulations, and drive continuous improvement in service delivery.
Key Responsibilities:
- Work with operations and providers to establish provider templates and scheduling protocols.
- Monitor multi-channel inbound patient requests to ensure timely response and accurate resolutions.
- Clinical triage of patient complaints over the phone.
- Coordinate with clinical teams in the field to provide accurate and timely information.
- Patient care follow-up.
- Follow-up on Labs, Imaging and Ordered Services, communicating results to providers and patients when appropriate.
- Assessing new patients by gathering information, reviewing diagnoses and reporting medical test results.
- Develop plans of care to address the needs of patients that match our growing programs.
- Educating patients about their care plan and health care options and helping them make key decisions.
- Scheduling appointments for doctors' visits, therapies and other medical services.
- Revising care plans based on patients' progress and input from physicians and other medical providers.
- Updating patient medical records after each contact.
- Offering emotional support for patients and their families.
- Designs an operational framework which ensures optimal program participation and prioritization of at-risk patients.
- Ensures adherence with disease specific treatment guidelines and objectives.
- Ensures effective communication among Chronic Care/Virtual care Team Members.
- Ensures two-way coordination with relevant On-Demand Providers, Patient Navigators, Nursing Teams, Residential Nursing, Enrollees, and CEO of Clinical Practice Group or designee.
- Routinely analyzes data from the electronic health record to determine patients at highest risk for health deterioration.
- Patient care coordination and care management activities.
- Assisting enrollees with appointments for OnDemand Providers.
- Assisting with Prior Authorizations, Referrals, &/or Medication refills.
- Updating Care Plans as needed.
- Assisting with the transition of care for patients discharged from the hospital or ER within hours to aid in the prevention readmission and related complications.
- Evaluate and provide appropriate follow-up care for recently discharged patients as directed by a licensed independent practitioner to prevent further disease exacerbation, complications, or additional ER or hospital utilization.
- Other services deemed necessary to both the organization's & patient's goals.
- Collaborates as needed across disciplines to coordinate care.
- Uses technology as a platform for patient care, navigates computer and other devices in the delivery of care.
- Assist in the development of a quality program and implement KPI's for team of inbound agents to drive best-in-class service and performance accountability.
- Implement daily QA/QI related to the program.
- Other duties as assigned.
- Minimum of two years of experience as a Registered Nurse licensed in California.
- CA Driver's License (minimum of 2 years) with an acceptable driving record.
- Active and current BLS.
- Supervisor experience required, people management.
- Must possess leadership and supervisory ability and the willingness to work harmoniously with and supervise other personnel.
- Emergency Department, Urgent Care, Internal Medicine, Hospital - Critical Care, Family Practice or other relevant areas experience preferred.
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