Disease Management Program Coordinator LCSW

• 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.

• Minimum four (4) years of behavioral health case management experience in a relevant chronic disease in an acute medical center, OR


• Minimum four (4) years of experience analyzing/improving  behavioral health care clinical practices/processes and clinical performance in an acute medical center.

• Masters degree in clinical social work from an institution accredited by the Council on Social Work Education

• Licensed Clinical Social Worker (California)

• Ability to conduct and utilize processes, principles and practices of program evaluation and case management modalities/interventions.


• Demonstrated knowledge of human development and psychotherapeutic theories/principles and practices.


• Ability to utilize project management skills and abilities, as well as consulting and interpersonal skills ( communication, influencing, negotiating, persuasion).


• Must be able to work in a Labor/Management Partnership environment.

• N/A.

Notes:

• LCSW New Position for Primary Care Plus Program.