Practice Care Manager RN, Clarksdale, MS - Full-time / Part-time

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Accountable Care Practice Care Manager (PCM) works with Community Plan leaders and leadership of assigned hospitals and physician practices in each Accountable Care Community.   PCM assumes responsibility for practices' high risk Health Plan members, and facilitates practices transformation from a reactive model of patient care to a proactive model by using practices population data to effectively measure, monitor and manage care, and presents outcomes to leadership in the Health Plan, the practices and the hospital.

PCM helps practices with transformation initiatives to improve Plan member access to care, manage member inpatient and ER care transitions, and manage high risk patients through pre-visit planning, addressing open care opportunities, managing referrals end to end and assuming responsibility for high risk member care coordination to reduce adverse events for patients.

 

 

The PCM is responsible for  a) care management of the practices' high risk members  and b) assisting the practices in implementing the United Accountable Care Communities program in the following key areas: 

§  Access to Care
Improve convenient access to care for the practices' Health Plan population.  Help practice leaders understand overall capacity/demand for appointments and visit patterns by practice and assist the Practices in implementing process improvements to increase same day visits and reduce no show rates.  Ensure newly assigned Plan patients have a PCP visit in first 90 days.  Increase same day visits to meet mutual goals of Practices and Plan.

§  Avoidable ER Use
Reduce inappropriate ER use for the practices'' Plan population.  Collaborate with practices to use daily hospital ADT and daily ER notifications to engage members to use PCP for primary care.  Identify trends in ER use by Plan members and work with all community stakeholders, including hospitals, to develop and implement proactive strategies to address issues, and measure impact Ensure that all Plan members with an ER visit complete a PCP follow up within 7 days of ER discharge.

 

§  Avoidable Inpatient Admissions/30 Day Readmissions
Reduce avoidable admissions and readmissions for the practice Plan population. Support practices in the effective use of the Accountable Care Population Registry to track and manage care transitions of all discharges and ensure follow up with a clinician within 7 days of discharge date.  .  Measure and monitor success of outreach and develop strategies to simplify processes and ensure optimal care for patients.
Ensure patients discharged from IP stay complete a clinical visit within 7 days of discharge.

 

§  Improve care of high risk/high cost cohort patients
Use predictive modeling analyses of practice population risk and population total costs of care and assist practices in identifying cohorts of high risk/high cost patients for focused improvement initiatives. Collaboratively establish practice clinical leadership measurable goals for each cohort to increase access with local Community Plan leaders, address current care gaps, improve subspecialty referral management, and reduce adverse events. Analyze and report measurable progress against goals internally and at monthly meetings with practices, the Health Plan and hospitals.

 

§  Disease management

Disease Management and lower level Case Management (completion of a HRA, Disease Management assessment, and creation of individual plan of care)

 

 

 

UnitedHealth Group is working to create the health care system of tomorrow.

 

 

 

Already Fortune 25, we are totally focused on innovation and change. We work a little harder. We aim a little higher. We expect more from ourselves and each other. And at the end of the day, we're doing a lot of good.

 

 

 

Through our family of businesses and a lot of inspired individuals, we're building a high-performance health care system that works better for more people in more ways than ever. Now we're looking to reinforce our team with people who are decisive, brilliant - and built for speed.

 

 

 

Come to UnitedHealth Group, and share your ideas and your passion for doing more. We have roles that will fit your skills and knowledge. We have diverse opportunities that will fit your dreams.

 

 

 

Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V

 

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.

 

Job keywords:  RN, Registered Nurse, Case Management, Disease Management, clinic, physician's office, doctor's office, high risk, chronic illness, health plan, and community based