SUMMARY:

Performs healthcare coordination and case management activities IAW Medical Treatment Facility (MTF) instructions.

 

ESSENTIAL DUTIES & RESPONSIBILITIES:

Ensures compliance with standards of care and practice (Accreditation Association for Joint Commission on Accreditation of Healthcare Organizations (JCAHO), Ambulatory Health Care (AAAHC) & Case Management Society of America (CMSA)). Collaborates with military and civilian healthcare providers and staff and uses Utilization Management (UM) systems support to identify high-risk/high-cost patients within MTF population. Determines eligibility for healthcare coordination/case management services. Coordinates with healthcare providers to ensure appropriate appointment alternatives, access and quality of care. Coordinates services for eligible patients based on subjective and objective assessment data and identified patient/family needs. Facilitates a multidisciplinary team to develop a treatment plan to address all identified conditions and problems.  Integrates health education, promotion and prevention activities utilizing available MTF and local civilian condition/disease management resources. Participates in the orientation, training, and evaluation of competency of newly assigned Case Management personnel. Attends bi-weekly and as-needed multi-disciplinary discharge planning conferences within the MTF and as needed at the local treatment facilities. Assists TRICARE eligible and Medicare-eligible patients in accessing local TRICARE and Medicare providers in conjunction with the MTF Referral Centers and the Central Referral Center. Maintains current directories of local Medicare providers, suppliers, and Institutions. Evaluates case management process utilizing defined parameters such as admissions, length of stay, level of care, Emergency Department/outpatient clinic visits and patient outcomes and institutes appropriate interventions. Generates and maintains appropriate patient administrative records and provides upon request. Reports monthly summary of care to Director, Medical Management (MM) or designee. Conducts monthly evaluation, in conjunction with Primary Care Management (PCM) team, the benefit of case management.  Closes case management cases when maximum patient benefit has been obtained. Ensures a safe work environment and employee safe work habits. Maintains regular and punctual attendance. Performs all other duties as assigned.

 

SUPERVISORY RESPONSIBILITIES

None.