Job Description

• Under the supervision of the Clinical Director, the clinical consultant is responsible for clinical oversight of BLEHEALTH CHWs, lead care managers, Home Care aides, and housing navigators, who address the patient’s medical and behavioral health needs and social determinants of health.
• The Clinical Consultant will communicate directly with Case Managers and with patients via telephone, or during in-person, Interdisciplinary Care Team meetings (as needed), to discuss medication management/adherence, ensure appropriate follow up with Primary Care Provider, Behavioral Health Provider and other specialist(s)
• They will provide guidance during any emergency situations encountered by Case Managers
• The Clinical Consultant will collaborate with the broader care team (PCP, BH clinicians, etc.) to provide client advocacy and ensure that the enrollees are receiving needed services and measuring progress towards the goals outlined in their patient-centered care plan
• Provides Clinical Oversight of comprehensive assessment, Health Risk Assessments and determines if Member’s Care Management needs are sufficient to be managed by a Lead Care Manager or require the Consultant’s intervention in the form of recommendations to implement in their Care Plan
• Participates in developing patient-centered care plans for the enrollees on their panel
• Approves Reviews and approves initial care plan and biannual updates
• Actively consults with Care Managers to review medical visit summaries, discharge papers, prepare for upcoming appointments, or review appointment outcomes
• Provides health and preventive care education for acute health conditions, chronic disease management, and medication monitoring
• Engages vulnerable populations as part of a multidisciplinary outreach team
• This includes home visits, accompaniment to appointments, outreach to hospitals, homeless shelters and other settings, as needed.
• Uses data to evaluate outcomes from targeted interventions
• Assists in developing appropriate adjustments to care plans based on this data
• Helps to expand programming that addresses SDoH and enhances connections to community-based organizations.
• Works with hospitals to coordinate hospital admission/discharge plans with the behavioral health clinician, PCP, pertinent specialists and other organizations with the goal of preventing readmission, if possible
• Performs timely medication reconciliation following transitions in care
• Supports medication adherence
• Perform chart review and case conferences with Case Managers
• Implements prevention & engagement activities
• Engages in quality improvement efforts
• Manages effectiveness of service delivery
• Ongoing client care coordination documentation monitoring includes assessments, care plans, community support referrals, outcome measures, and progress notes
• Ensures timely and high-quality documentation of services by staff in accordance with all agency and contractual requirements
• Train, monitor, and support staff to provide appropriate services to managed care members and ensure ongoing achievement of quality measures
• Ensure culturally appropriate and timely in-person clinical activities
• Maintains ongoing communication with managed care providers (MCP) and other contractual partners
• Ongoing communication and collaboration with MCP, provide updates on program efforts
• Ensure timely outreach to eligible members
• Responsible for timely reporting, billing, and effectiveness of data management systems
• Ensure accurate data input in compliance with MCP standards and requirements
• Work with the organization as necessary to carry out supervisorial responsibilities
• Analyze and identify tailored solutions for our member's specific needs, aligning with their unique requirements.

Qualifications
• Registered nurse with current licensure to practice professional nursing in the State of California.
• Bachelor’s degree in Nursing from an accredited program by the National League for Nursing. Master’s degree in health care preferred.
• Three years of management experience within the last five years in a home health or related health care organization, at least one year of which was a supervisory or administrative capacity.
• A registered nurse with four years of experience within the last five years in a home care agency, primary care clinic or health facility, at least one year of which was in a supervisory or administrative capacity.
• Demonstrated ability to supervise and direct professional administrative personnel.
• Knowledge and expertise in clinical decision-making and Quality Management review and evaluation.
• Ability to market and deal tactfully with customers and the community.
• Must be a licensed driver with an automobile that is insured in accordance with state and/or Organization requirements and is in good working order.
• Has excellent observation, verbal and written communication skills.
• Knowledge of business management, and governmental regulations.
• Participation in Quality Assurance/Performance Improvement Program.

Job Tags

Similar Jobs