Patient Care Specialist - Santa Rosa, United States - Sutter Health

Sutter Health
Sutter Health
Verified Company
Santa Rosa, United States

3 weeks ago

Mark Lane

Posted by:

Mark Lane

beBee recruiter
Description

Organization:

SSRRH-Sutter Santa Rosa Reg Hospital


Position Overview:

Substance and Behavioral Health Navigation

  • These Principal Accountabilities, Requirements and Qualifications are not exhaustive, but are merely the most descriptive of the current job. Management reserves the right to revise the job description or require that other tasks be performed when the circumstances of the job change (for example, emergencies, staff changes, workload, or technical development)._

JOB ACCOUNTABILITIES:


WORKFLOW OF THE PROGRAM:

  • Develop stepbystep process for each Program.
Analyze and determine steps that need to be taken in order to successfully achieve program roles.

  • Supports the identification and ranking of Pay for Performance (P4P) disease specific member populations; support and coordinate the development and distribution of standardized and other ad hoc reports.
  • Conducts initial review and analysis of population lists/reports.
  • Works with reporting analysts to develop and maintain processes and timelines for population identification, stratification and reporting based on defined criteria.
  • Collaborates with management and P4P project team and/or appropriate external staff for report interpretation.
  • Assist with creating annual P4P Outreach work plans and maintains schedule tasks.
  • Monitor accuracy and completeness of data collected and recommends improvements to data collection tools and processes.
  • Supports and is accountable for the accuracy of patient identification, status related to P4P identification rules used within the P4P Outreach process, including adequate review and testing.
  • Develops/obtains all records, forms and printed materials needed to initiate P4P outreach process.
  • Build and maintain relationships with physicians, staff, labs and vendors to ensure smooth coordination of efforts. Identify and resolve any issues that could impinge the smooth workflow of processes, including coding, products, referral requests, etc
  • Maintain spreadsheets and/or databases to track the sequential contact activity of each identified member and to "work" the list to perform the next level of communication in the predetermined timeframes.
  • Coordinate and perform the outbound communication processes through the use of a series of escalating communication venues.
  • Maintains patient letters, PCP faxes, client correspondence and
- related documents and files; develops and maintains storage filing system, including back-up procedures for all documents and correspondence.

  • Coordinate vendor activities to ensure smooth patient communications. Work with outside vendors to set up outbound Televox calls and automated MSI letters for identified members. Audit communications to ensure accuracy.
  • Contribute to the development, implementation and monitoring of policy and procedure relating to the operations of the P4P Outreach processes.

RELATIONSHIPS:

  • Serves as general operations resource to the P4P Outreach team.
  • Act as P4P Outreach liaison to clients, imaging centers, labs and providers for issues related to P4P Outreach, ensuring a complete understanding of expectations and requirements.
  • Research and/or verify member issues; seek resolution using a variety of resources.
  • Act as a liaison between the member and their physician's office or the labs to assist in the coordination of scheduling appointment(s) and/or resolution of issues.
  • Influence member participation in the program, using persuasive and motivational techniques to encourage members to complete recommended steps to comply with Outreach objectives (e.g. schedule appointments for tests and procedures, such as mammogram, complete lab work, etc).
  • Coordinates patient callbacks as needed to assure optimal outreach resolution (compliance) is reached with identified patient population.
Tracks and reports completion of screening/intervention with laboratories, imaging centers or other means (e.g. coordinating with reporting analyst using claims data) to ensure patient follow through on intervention and outreach efforts.

  • Supports the coordination of physician office staff education on P4P Outreach issues.
  • Prioritizes and reports concerns, improvements, and possible quality issues.
  • Maintains administrative statistical reports, department files, reference materials, and policy manuals to ensure proper availability and retrieval.
  • Coordinates and problemsolve all information system issues with the appropriate department.

REPORTS:

  • Compiles, maintains and reports information on operations, including productivity, quality improvement and related data in a complete and accurate, and accessible manner.
  • Communicates with members, physicians and foundations/clients as directed by program policies.
  • Track and analyze utilization statistical data and presents to administration regularly or as needed.
  • Attend any/all department and company meetings as indicated by the Disease Management Manager.
  • Adheres to org
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