El Monte, CA, US
Contract to Hire
$25.00 - $30.00 /Hour
Provide efficient and effective Ambulatory Care Management to members with high risk for hospitalization, re-admission and/or increased utilization of services by addressing the member's medical, physical and psycho social needs. Using clinical judgment develops, modifies and assists the member to implement their care plan.
ESSENTIAL DUTIES AND RESPONSIBILITIES
Complies with department policies & procedures to ensure all appropriate assessment for the eligible population are completed and acted upon within established time frames.
Responsible for reviewing Health Plan reports/request for new members assigned to SPD, SNP and Cal Medi-Connect requiring Continuity of Care (COC).
Responsible for the care management (coordination of outpatient care) of members with catastrophic illnesses and chronically ill while ensuring quality of care standards is met by using clinical judgment to assess and/or evaluate.
Case load: Minimum 10 cases per day
Responsible to identify and evaluates members for enrollment into one of the case management program: Cal Medi-Connect, Complex Case Management, SNP, Transplant, CCS, Member Education, ESRD…etc. and update progress to various health provider (including but not limited to health plan, physician, and member) to ensure COC.
Responsible for monitoring and /or processing Transplant and COC request.
Maintain a data base for tracking Transplant, ESRD and COC-related activities.
Responsible for health plan reporting with Transplant, ESRD, COC-related request.
Conducts telephonic assessments to identify member's medical, physical and psychosocial needs.
Assess identified members in a timely fashion to ensure appropriate individualized care plans are developed with the member to eliminate or reduce unnecessary admissions/re-admissions.
Based upon care management criteria, contact and completes assessments for members identified as potential candidates for care management.
Evaluates assessment findings against evidenced-based guidelines to develop a plan of care based on member needs and findings with collaboration from the interdisciplinary team.
Identifies potential barriers to adherence to treatment plan and modifies plan by mutual agreement with the member.
Educates member/caregiver on specific disease using approved evidence-based guideline and; using clinical judgment, modifies plan of care/goals based on member's readiness to change.
Facilitates care coordination across the care continuum (home, hospital, home health), identifies community resources and makes referrals as appropriate.
Encourage members to take an active role in both chronic disease and health prevention utilizing self-management support and patient education.
Discuss self-management goals with the patient and assists them in selecting appropriate goals.
Consistently documents activities and interventions provided to the member.
Attends/participates in staff meetings and interdisciplinary team meetings.
Prepares and present cases in Interdisciplinary Care Team meetings.
Evaluates assessment finding, develops case presentation for the Interdisciplinary Care Team
(ICT) and incorporates ICT recommendations into the member's care plan.
Promotes appropriate utilization of benefits
Assesses cultural and linguistic needs and preference
Participates in all health plan audit preparation.
Participates in all health plan seminars and training as applicable.
Develop a working relation with internal departments to maintain the flow of needed information.
Submit reports and statistics as applicable.
Performs other duties and task as assigned.
We know that a company's success starts with its employees. We also know that an individual's success starts with the right career opportunity. As a Best of Staffing® Client and Talent leader, Aerotek's people-focused approach yields competitive advantage for our clients and rewarding careers for our contract employees. Since 1983, Aerotek has grown to become a leader in recruiting and staffing services. With more than 250 non-franchised offices, Aerotek's 8,000 internal employees serve more than 300,000 contract employees and 18,000 clients every year. Aerotek is an Allegis Group company, the global leader in talent solutions. Learn more at Aerotek.com.
The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
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