<p>Job Summary:</p> <p>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.</p> <p>Essential Responsibilities:</p> <ul> <li>Responsible for coordinating an integrated systematic care management process/ program based on clinical pathways, protocols and guidelines. </li><li>Such program directs the member/patient to appropriate and timely specialty diagnostic and treatment care services across the full continuum of care. </li><li>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. </li><li>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. </li><li>Utilizes a multi-disciplinary team approach/process to develop and implement clinical pathways and care management interventions. </li><li>Identify and stratify at-risk patient populations. </li><li>Analyze practice patterns/variations. </li><li>Establish care/treatment benchmarks. </li><li>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. </li><li>Pilot tests new and administers/communicates on-going program in conjunction with Chief Physicians and care providers/managers. </li><li>Manages disease-specific data collection, analysis, and reporting based on financial, clinical, utilization, cost, best practices, and baseline metrics. </li><li>Problem solves program issues and treatment variations. </li><li>Analyzes program outcomes actually achieved vs intended outcomes. </li><li>Monitors and resolves program compliance issues involving providers and patients. </li><li>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. </li><li>Conducts analyses related to protocol/treatment plan compliance as well as clinical, quality, communication, financial/cost outcomes and makes recommendations for program revisions. </li><li>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. </li><li>Acts as organization liaison with relevant community agencies, organizations and task forces. </li></ul>