What are the responsibilities and job description for the LCSW - Disease Management Program Coordinator - South Bay - FT position at Kaiser Permanente?
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.
Qualifications:
Basic Qualifications:
Experience
- Minimum four (4) years of behavioral health case management experience in a relevant chronic disease in an acute medical center, OR
- Minimum four (4) years of experience analyzing/improving behavioral health care clinical practices/processes and clinical performance in an acute medical center.
Education
- Masters degree in clinical social work from an institution accredited by the Council on Social Work Education
License, Certification, Registration
- Licensed Clinical Social Worker (California)
Additional Requirements:
- Ability to conduct and utilize processes, principles and practices of program evaluation and case management modalities/interventions.
- Demonstrated knowledge of human development and psychotherapeutic theories/principles and practices.
- Ability to utilize project management skills and abilities, as well as consulting and interpersonal skills ( communication, influencing, negotiating, persuasion).
- Must be able to work in a Labor/Management Partnership environment.
Preferred Qualifications:
- N/A.
Notes:
- Will help in Bridge Clinic/Program, HUB, ETC, Complex Care and PC plus departments
- May work Monday through Sunday with rotating work weekends.
