Location: Richmond, VA
Schedule: Monday-Friday
Pay Range: $41.60-46.34 per hour, dependent on experience
The Care Manager 3 is responsible for triaging, coordination, documentation, communication, and tracking of patient calls, cases, and records for a panel of critical and high acuity Traditional Medicare and Medicare Advantage Plan patients engaged in Complete Health Care Management programs and initiatives.
Care Management services are focused on critical or high risk, chronically ill, and post-acute patients, and include a combination of non-face-to-face and in-person communication (electronic or phone) with patient (or HIPAA Rep) and clinical staff, physician, or other qualified health care professionals. However, the frequency and length of management is conducted as the patient's medical condition warrants. During the management period, a plan of care is established and implemented, and is reviewed and/or revised during each subsequent encounter.
A plan of care includes an electronic summary of the patient's physical, mental, cognitive, psychosocial, functional, environmental, and social assessments. It contains a record of all recommended preventive care services, medication reconciliation with review of adherence and potential interactions and oversight of patient self-management of medications, an inventory of clinicians, resources, and supports specific to the patient; including how the services of agencies and/or specialists unconnected to the designated physician's practice can be coordinated. It includes ensuring that ER and hospital clinical documents, consult notes and other records of care are current and available on the chart for review as needed.
The Care Manager 3 is responsible for ensuring that care and services are delivered appropriately and timely to his/her panel of patients. Under direction of and collaboration with the primary care provider and Value Based Care leadership, the Care Manager 3 identifies and delivers the appropriate level of care needed by each patient in his/her care. He/she oversees and ensures that each patient receives regular and thorough assessments, triage, medication reconciliation, ongoing goals of care assessments, and follow up as their ongoing condition and acuity status requires.
The Care Manager 3 coordinates efforts with the Quality Department to ensure that each patient is accurately assessed, and that Annual Wellness Visits are completed quality measures and gaps are closed. He/she accurately updates patient's problems list, diagnoses, health conditions, mediations list and Care Team and escalates concerns to the primary care provider.