Disease Management Program Coordinator (LCSW)

Description : Job Summary :

Collaborates with Chief Physicians, staff physicians and managers / care providers from multiple disciplines / departments to manage the planning, development, implementation / delivery and evaluation / improvement of a disease management program for at-risk patients in a behavioral healthcare population defined by a chronic psychiatric disease state or disorder such as, but not limited to, characterological disorders / conditions, depressive, anxiety and / or personality disorders, dual diagnosis, substance addiction, autism.

Essential Responsibilities :

• Responsible for coordinating an integrated systematic care management process / program based on clinical pathways, protocols and guidelines.
• Such program directs the member / patient to appropriate and timely specialty diagnostic and treatment care services across the full continuum of care.
• Provides comprehensive on-going care management that meets established standards / benchmarks for efficiency, improved clinical outcomes, quality, resource utilization, cost effectiveness, evidence-based treatment plans and improves members quality of life and satisfaction.
• In the program planning / development stage, acts as project manager to develop a strategic / business plan which meets access, cost, quality and member / patient satisfaction goals and needs.
• Utilizes a multi-disciplinary team approach / process to develop and implement clinical pathways and care management interventions.
• Identify and stratify at-risk patient populations.
• Analyze practice patterns / variations.
• Establish care / treatment benchmarks.
• Design a disease care model for analyzing disease components and interventions which addresses all components of patient care including patient self-management, education / teaching, and stratified interventions based on illness severity and co-morbidities.
• Pilot tests new and administers / communicates on-going program in conjunction with Chief Physicians and care providers / managers.
• Manages disease-specific data collection, analysis, and reporting based on financial, clinical, utilization, cost, best practices, and baseline metrics.
• Problem solves program issues and treatment variations.
• Analyzes program outcomes actually achieved vs intended outcomes.
• Monitors and resolves program compliance issues involving providers and patients.
• Evaluates disease management program in terms of utilization review / resource issues such as treatment variances, goal achievement of interventions, effective interaction between all clinicians / providers, appropriateness of program care model, quality improvement and patient / member satisfaction.
• Conducts analyses related to protocol / treatment plan compliance as well as clinical, quality, communication, financial / cost outcomes and makes recommendations for program revisions.
• Monitors, evaluates and improves patient access provided by care managers via telephone and other means in order to improve patient self-care / management, compliance and participation in care processes.
• Acts as organization liaison with relevant community agencies, organizations and task forces.

Basic Qualifications :

Experience

Education

License, Certification, Registration

Additional Requirements :

Preferred Qualifications :

Notes :