Purpose Statement / Position Summary

Under the direction of the ACO Executive Director and MedicalDirector, the Care Manager for the ACO will follow a collaborative process toassess, plan, implement, coordinate, monitor and evaluate the options andservices available to meet an individual's health needs.  The Care Manager for the ACO is responsiblefor the identification, evaluation and coordination of health care servicesprovided to the ACO members.

Essential Functions and Responsibilities of the Job

• Strongverbal and written communication skills

• Abilityto complete work independently and collaborate with internal and external teammembers and participate in ACO and/or related meetings, committees or function

• Computerliteracy with ability to work within several internal and external on line andWeb based systems, reports and analytics

• BasicMath Skills

• Understandingof privacy and HIPAA standards

• Flexibilityand multi-tasking skills

• Beat work and be on time

• Followcompany policies, procedures and directives

• Interactin a positive and constructive manner

• Prioritizeand multitask

Essential Job Outcomes 

• Identifiesand evaluates members for enrollment into one of the ACO Care Managementprograms through the following mechanisms:

                              a) Physicianreferral

                              b) High-riskscreening tools

                              c)Ambulatory utilization

                              d) Inpatientconcurrent review (acute/sub-acute)

                              e) Diagnosisscreening criteria

               f) Family Member/significantother referral

               g) Data analysis reports

Assesses,plans, implements, coordinates, monitors, and evaluates health services withthe goal of optimizing the member's health status.

• Integratesevidence-based clinical treatment guidelines, preventive guidelines, protocols,and quality metrics in the development of treatment plans

• Develops careplans that are patient-centered, promoting efficiency, access and quality inthe delivery of healthcare for the ACO members.

• Developssystems of care that monitor member progress and promote early interventionwhen healthcare needs or gaps in care are identified

• Workseffectively with other members of the health team to optimize interventions;coordinating health care services with physicians, facilities, contractedproviders, and ancillary providers; acting as liaison between member,HealthCare Team, community programs and services and the Memorial HealthSystems medical leadership.

• Managesutilization and practice metrics to further refine the delivery of care modelto maximize quality, clinical, and fiscal outcomes for the ACO population.

• Collects andanalyzes health services data, including but not limited to emergency careutilization, care gap opportunities, admission and readmission reports toidentify which members need care coordination and post-acute care management.

• Whenapplicable, refers members to and collaborates with appropriate health planretained functions in Care Management including; Transplant, TransgenderReassignment Surgery, Bariatric Surgery, Complex Newborn/NICU, Eliza (IVR WarmTransfer), Behavioral Health, Investigational/Experiment services, BenefitSubstitution Period, Out of Area care.

• Acts asresource for department staff, inter-departmental staff, contracted physicians,health plans, contracted facilities, members/families and ancillary providers.

• Providesany/all Memorial Health Systems (MMG or Nautilus) Committees with comprehensivesummary of all care management activities as required

• Attends andparticipates in   patient careconferences and or related ACO meetings as necessary

• Providesany/all Memorial Health Systems (MMG or Nautilus) Committees with comprehensivesummary of all care management activities as required

• Other dutiesas assigned