Works under the direction of the ACO Medical Director and Care Coordinator Manager in the area of Care Management and Population Health. A prime area of focus will be case management of higher risk patients. Other areas of focus may include transitional care management, population health management, quality improvement, and provider and staff education.
Education: Completion of an accredited MSW program.
Work Experience: Minimum of two years of experience in case management, preferably in a medical setting
Preferred Experience/Qualifications: Prior experience in case management, population health management, utilization management and quality programs. CCM credential is desirable.
Other Qualifications: Excellent written and verbal communication skills. Proficient with MS Word, Excel and Outlook. Valid Arizona driver’s license and reliable transportation.
Summary: This position is responsible to carry out service as a Pediatric Care Manager and will provide patient and family-centered care coordination to address medical, social, developmental, behavioral, educational and social/financial needs while facilitating strong community relationships across the care continuum. The Pediatric Care Manager will actively work with patients, parents/caregivers and health care team members to meet the needs of the pediatric population.
• Accept pediatric patient referrals and enroll them into care management programs as appropriate.
• Conduct a comprehensive assessment with the child/youth that includes family status and home environment assessment.
• Carry an active caseload of not more than 1:100, by utilizing community resources for case management when appropriate and supervising population health Medical Assistants for lower acuity follow up.
• Engage patients, parents/caregivers, and health care providers to develop and implement integrated care plans that: build on family strengths, plan for the transition of youth from pediatric to adult systems of care, as appropriate, and (if applicable) be developed with input from behavioral health Child and Family Teams.
• Conduct ongoing assessments as needed to facilitate the update and modification the integrated care plan
• Coordinate medical and behavioral health services, assuring optimal communication and collaboration with MCO and/or other practice case or care management staff so that duplication in efforts does not occur and that member needs are addressed as efficiently as possible.
• Ensure patient, parent/caregiver, and families receive the education necessary build self-management skills and understand how to confidently navigate a complex health care system.
• Work with patients, parents/caregivers and their families to facilitate links to community organizations, including social service agencies.
• Advocate for patients and parents/caregivers to resolve health and social crisis that negatively impact the patient
• Maintain a variety of records, including but not limited to individual patient records, registries and referrals
About this company
Founded in 1994, Arizona Community Physicians is a physician-owned, predominantly primary care medical group practice, with offices in Tucson, Oro Valley, and Green Valley.
Since its inception, ACP’s goal has been to be a patient-centered, full-service, physician-owned medical group providing comprehensive outpatient services. We strive to develop personal, long-term relationships between our patients and their physicians, nurse practitioners, physician assistants and ACP office staff.
Today, we are Arizona’s largest and most successful physician-owned medical group. ACP is a forward looking organization consisting of approximately 800 employees. Our group includes 166 providers in the specialties of family medicine, internal medicine, geriatrics, pediatrics, endocrinology, rheumatology, dermatology and gynecology. We are located in 50+ locations of varying sizes in Tucson, Oro Valley, and Green Valley.
As a physician group, we also are aware that the growth in health care costs is not sustainable over time, which is why we formed Abacus Health, an accountable care organization. We believe there is room to improve efficiencies as we improve patient care and we applaud restructuring the system to recognize providers for the good work they do in making patients healthier and improving their satisfaction.
Location/Region: Tucson, AZ