Behavioral Health Chronic Care NP, Population Health - Part Time, Days - Prospect Medical Holdings, Inc.

Seated: HYBRID-REMOTE: California Based, must live in the greater Los Angeles Region and be able to travel to our California Hospitals. The Behavioral Health Chronic Care NP is required to participate in the community, at the local hospitals, with affiliated medical groups and within CRC programs for implementation and development of the clinical chronic care behavioral health program.\n Prospect Medical Holdings' ability to deliver quality, compassionate care during the unprecedented pandemic affirms the original vision of its founders. This is the fulfillment of the hopes Prospect's founders had for the company, and proof that a clear vision, an insightful operating model, and a commitment to communities and our employees, born in the past, remains the way of the future.\n
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\n Every day, our more than 11,000 affiliated physicians and 18,000 employees at 17 hospitals, 165 outpatient centers and 28 medical groups provide nationally recognized care in six states. Our comprehensive network of quality healthcare services is designed to offer our patients and 600,000 members highly coordinated, personalized care tailored to the unique needs of each community we serve-many of which provide essential medical services to underserved communities as safety-net hospitals.\nMinimum Education: Unencumbered California Registered Nurse (RN), with Graduate or Doctorate Degree in Nursing. Board Certified Nurse Practitioner (NP-BC) with a specialization in Behavioral Health.
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Minimum Experience: Five (5) years of experience in an Acute Care, role, with at least three (3) years in a care management level role required. Behavioral Health Chronic Care NP must have care management leadership and medical group/MSO care management experience preferrable in complex patient management, chronic care management and/or population health role. Behavioral Health Chronic Care NP is responsible for the successful performance improvement of the health of patients under managed care agreements. Must have excellent verbal and written communication skills with fast paced problem-solving skills and the confidence to quickly implement resolutions. Behavioral Health Chronic Care NP will be required to have skills to independently utilize software such as Outlook, Word, Visio, Power Point, and Excel, as well as electronic health record documentation and research expertise, preferable with Allscripts EHR.
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Behavioral Health Chronic Care NP must have fluency of standard care management and utilization screening tools such as MCG and InterQual. InterQual or MCG Certified Instructor preferred. Expertise in operationalizing and executing a Behavioral Health Care Management Plan, hold a keen understanding of Daily Discharge Multi-Disciplinary Meetings, advanced experience with Allscripts Care Management tools, or similar management tools. Must hold experience with Care and Population Management & EMR Systems, such as, EPIC, Meditech, Cerner, Allscripts Care Management, knowledge of diagnosis related group (DRG), value based, risk based (capitation) and per diem payment methodologies.
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Must hold knowledge of all Federal, State and Local regulatory standards, have an advanced level knowledge of healthcare systems and applications to be able to successfully plan and coordinate activities and serve as a key resource to staff and others across the organization. Behavioral Health Chronic Care NP must have excellent written and verbal communication skills in English and be confident presenting to all levels of the organization. Must have prior management experience in a large multi-entity healthcare organization preferred specifically in the Population Health arena. Previous Experience across multiple healthcare settings (in-patient acute care, ambulatory, and long-term care) preferred.
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Req. Certification/Licensure:
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• Current Licensure as a CA Registered Nurse required as well as Board Certified Nurse Practitioner license
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• NP-BC preferred
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• AHA Basic Life Support
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• AHA Advanced Cardiac Life Support
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The CRC Behavioral Health Chronic Care NP will facilitate coordination, communication, and collaboration with patients, providers, ancillary services, and leadership to achieve goals and maximize patient outcomes through an innovative whole person chronic care strategy by working with CRC, Hospitals, Clinics, Management Service Organizations (MSOs) and Independent Physician Association (IPAs). Best practice focus will be placed on the provision of care which includes the recognition of the behavioral health issues as well as chronic care issues in the most appropriate clinical setting, efficient patient management through chronic care management and leadership escalation to ensure appropriate use, level of care and timeliness of services.
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The Behavioral Health Chronic Care NP will have patient responsibility for these complex care management functions:
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• Ambulatory Case Management - Complex and High Intensity
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• Behavioral Health Management
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• Disease Management Programs
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• Complex Care Services Performance Improvement Program (CCSPIP)
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• Initial and On-Going Chronic Care Planning (For patients who are affected with behavioral health issues)
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In partnership with the Population Health Director, the Behavioral Health Chronic Care NP ensures the aforementioned programs are a collaborative process of identification, assessment, planning, intervention, coordination and evaluations and as appropriate, integrates the participation of all those involved in the care of the member, including the primary care physician, medical and surgical specialists, nurses, behavioral and mental health specialists, physical, occupational, and speech therapists, social workers (LCSW), allied health professionals, and community-based providers. On an ongoing basis the Behavioral Health Chronic Care NP assures the following goals are achieved, including, but not limited to:
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• Proactively identifying members with serious and complex behavioral health conditions,
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• Screening and identifying appropriate patients for the CCSPIP,
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• Receiving and managing responses to referrals from MSO, Hospitals, Physicians and Medical Director/delegates,
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• In concert with the Chronic Care Population and Health Director, Manager, Medical Director, Social Worker(s), Care Transitions Coach (CTC), Community Health Worker (CHW), and RN Care Managers enhances the member's independent living capabilities, maximizes their optimal functioning and management of their chronic conditions to improve outcomes and quality of care.
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• Facilitating continuity and coordination of care the member receives between providers, facilities, community resources and the health plan,
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• Facilitating interdisciplinary communication, and care planning to promote member adherence with the physician's treatment regimen,
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• Enhancing member satisfaction with Prospect's health care delivery system,
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Coordinating member's eligible benefit coverage to best serve their medical conditions and social needs.
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Utilize creative solutions to assist member's care team (i.e. LCSW, CTC, CHW, Hospital and MSO Care Managers) with meeting the needs of complex, vulnerable and underserved patients, including those with barriers to discharge (i.e. difficult to place upon discharge, history of Substance use disorders (SUD), failure to adhere to plan of care/discharge plan due to drug, alcohol and /or behavioral health issues),
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• Through the coordination of cost-effective alternatives, especially as they relate to CalAIM, develops an individualized, comprehensive, multidisciplinary care plan that best meets the member's medical psychosocial and behavioral health needs and;
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• Provides consistently positive, constructive interface with internal departments, community partners, and physicians as needed.
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Under the direction of the CRC Director of Population Health and Care Management, the Behavioral Health Chronic Care NP is responsible to implement and guide the CRC care coordination for Behavioral Health Management, Complex and Disease Management, and Complex Care Services Performance Improvement programs.
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Job Responsibilities/Duties
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• The Behavioral Health Chronic Care NP implements programs within assigned areas. Position requirements include a thorough knowledge of the organization's policies, procedures, workflow, monitoring and oversight tools, employee relations, company goals and vision. Behavioral Health Chronic Care NP must have strong leadership skills with the ability to influence and motivate interdisciplinary team members. Successful Behavioral Health Chronic Care NP will have persistence to challenge and move Behavioral Health patients through the care continuum without losing focus of the quality and cost of care.
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• The Behavioral Health Chronic Care NP sees patient and system challenges and obstacles as opportunities for innovation and success. This person possesses the ability to work independently, remotely and has a passion to create a lasting impact on patient's lives and health.
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• Behavioral Health Chronic Care NP must have the ability to prioritize competing demands and promote a multidisciplinary team approach with strong problem-solving skills and attention to detail. The Behavioral Health Chronic Care NP is responsible for consistent operational compliance and reporting to satisfy and exceed state, federal and accrediting agency standards.
\n
• Must have experience developing and implementing new programs, which includes but is not limited to those which support the management of behavioral health patients with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care to prevent re-admission and avoidable emergency service utilization. The Behavioral Health Chronic Care NP ensures that Members' medical, environmental, and psychosocial needs are optimized through the continuum of care.
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• Behavioral Health Chronic Care NP participates as needed in physician/hospitalist, daily and weekly operational, department meetings, Joint Operating Committee (JOCs) and MSO daily rounds meetings as delegated by the Medical Director or Population Health and Care Management Director. Behavioral Health Chronic Care NP assists Medical Director and Population Health and Care Management Director with the daily clinical operations, compliance, and oversight of programs. Participates as the liaison and contact for operational teams' members and is responsible for communication, coordination and monitoring of organization-wide chronic care initiatives and operations related to in/outpatient case management programs.
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• Plans, develops, implements, evaluates, refines care management intervention(s), and provide coaching and guidance to the Clinical Management staff for effective and efficient operation of behavioral health service, community care and other chronic care management programs.
\n
• Participates in the daily management of care and disease management functions, daily in-patient rounds, MSO in/outpatient high intensity rounds, home visits, social workers, palliative, hospice, and home medication therapy management programs. Interfaces with CRC and MSO Medical Directors and attends / participates in Interdisciplinary Rounds.
\n
• Works collaboratively with Medical Director and Population Health and Care Management Director to ensure compliance is maintained, identifies specialist issues, reviews re-admissions and avoidable admissions.
\n
• Coordinates provisions for complex ambulatory care (disease management, social services, behavioral health, palliative/hospice, health education, community resources, etc.)
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• Demonstrates consideration for the needs, clinical and financial, of the patients, payers, CRC clinical and partner MSO | IPA team members. Implement and support a culture of continuous quality improvement, regulatory and accreditation code of professional conduct, and the federal and state regulations on confidentiality, as well as all policies and procedures Prospect Medical Holdings Hospitals.
\n
• Coordinates the collaboration with patient's family and physicians for seamless coordination of care and services. Monitors and evaluates effectiveness of the chronic and end of life care management plan(s) and modifies as necessary to meet health plans and national standards (i.e., NCQA and DMHC requirements) for turn-around-time for assessments, care plans and Interdisciplinary Teams (IDTs).
\n
• Identifies and implements Initial Care Plan (ICP) by conditions identified in CCSPIP, patient assessment, medical records, authorizations/referrals, primary care physician, hospitalist, member, and interdisciplinary team. Works to develop patient prioritized self-management goals addressing both clinical and identified social drivers of health (SDOH) needs.
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• Create cases in the care management platform for each patient under care management with appropriate documentation including but not limited to cognitive function, ADL, environmental factors, psychosocial, medical history, medications, and benefits, etc.
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• Has the understanding and ability to escalate when situations present and need additional leadership intervention.
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• Develops and coordinates care plan and/or assessment findings with MSO/health plan care managers, and/or county behavioral health services/departments as appropriate to support the member's needs. Utilize available Health Information Exchange Systems (HIE) as available to maximize resources, and information available to develop a safe plan for each at-risk patient.
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• Manages a case load of chronic and high-risk patients in collaboration with Medical Director, Director of Population Health and Care Management as well as respective MSO/IPA partners.
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• Meets assigned / expected patient contacts daily to assess and coordinate care.
\n
• Complies and measures performance indicators, trends, and staff activity report relevant to CCSPIP, case management, disease management and other programs.
\n
• Analyze and manage the review of high-cost claims and coding review.
\n
• Develops workflows and processes to support care management operations
\n
• Develop the team objectives and goals with support to the organization and departmental strategic plans.
\n
• Ensures compliance is maintained with all health plan, state, deferral, and accrediting agency standard, e.g., NCQA/CMS regulations/delegation.
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• Expected to pursue ongoing education, certification, and self-development to remain current with industry standards and business objectives related to Behavioral Health Care Management.
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The CRC Behavioral Health Chronic Care NP will facilitate coordination, communication, and collaboration with patients, providers, ancillary services, and leadership to achieve goals and maximize patient outcomes through an innovative whole person chronic care strategy by working with CRC, Hospitals, Clinics, Management Service Organizations (MSOs) and Independent Physician Association (IPAs). Best practice focus will be placed on the provision of care which includes the recognition of the behavioral health issues as well as chronic care issues in the most appropriate clinical setting, efficient patient management through chronic care management and leadership escalation to ensure appropriate use, level of care and timeliness of services.
\n
The Behavioral Health Chronic Care NP will have patient responsibility for these complex care management functions:
\n

\n
• Ambulatory Case Management - Complex and High Intensity
\n
• Behavioral Health Management
\n
• Disease Management Programs
\n
• Complex Care Services Performance Improvement Program (CCSPIP)
\n
• Initial and On-Going Chronic Care Planning (For patients who are affected with behavioral health issues)
\n

\n
In partnership with the Population Health Director, the Behavioral Health Chronic Care NP ensures the aforementioned programs are a collaborative process of identification, assessment, planning, intervention, coordination and evaluations and as appropriate, integrates the participation of all those involved in the care of the member, including the primary care physician, medical and surgical specialists, nurses, behavioral and mental health specialists, physical, occupational, and speech therapists, social workers (LCSW), allied health professionals, and community-based providers. On an ongoing basis the Behavioral Health Chronic Care NP assures the following goals are achieved, including, but not limited to:
\n

\n
• Proactively identifying members with serious and complex behavioral health conditions,
\n
• Screening and identifying appropriate patients for the CCSPIP,
\n
• Receiving and managing responses to referrals from MSO, Hospitals, Physicians and Medical Director/delegates,
\n
• In concert with the Chronic Care Population and Health Director, Manager, Medical Director, Social Worker(s), Care Transitions Coach (CTC), Community Health Worker (CHW), and RN Care Managers enhances the member's independent living capabilities, maximizes their optimal functioning and management of their chronic conditions to improve outcomes and quality of care.
\n
• Facilitating continuity and coordination of care the member receives between providers, facilities, community resources and the health plan,
\n
• Facilitating interdisciplinary communication, and care planning to promote member adherence with the physician's treatment regimen,
\n
• Enhancing member satisfaction with Prospect's health care delivery system,
\n

\n
Coordinating member's eligible benefit coverage to best serve their medical conditions and social needs.
\n
Utilize creative solutions to assist member's care team (i.e. LCSW, CTC, CHW, Hospital and MSO Care Managers) with meeting the needs of complex, vulnerable and underserved patients, including those with barriers to discharge (i.e. difficult to place upon discharge, history of Substance use disorders (SUD), failure to adhere to plan of care/discharge plan due to drug, alcohol and /or behavioral health issues),
\n

\n
• Through the coordination of cost-effective alternatives, especially as they relate to CalAIM, develops an individualized, comprehensive, multidisciplinary care plan that best meets the member's medical psychosocial and behavioral health needs and;
\n
• Provides consistently positive, constructive interface with internal departments, community partners, and physicians as needed.
\n

\n
Under the direction of the CRC Director of Population Health and Care Management, the Behavioral Health Chronic Care NP is responsible to implement and guide the CRC care coordination for Behavioral Health Management, Complex and Disease Management, and Complex Care Services Performance Improvement programs.
\n
Job Responsibilities/Duties
\n

\n
• The Behavioral Health Chronic Care NP implements programs within assigned areas. Position requirements include a thorough knowledge of the organization's policies, procedures, workflow, monitoring and oversight tools, employee relations, company goals and vision. Behavioral Health Chronic Care NP must have strong leadership skills with the ability to influence and motivate interdisciplinary team members. Successful Behavioral Health Chronic Care NP will have persistence to challenge and move Behavioral Health patients through the care continuum without losing focus of the quality and cost of care.
\n
• The Behavioral Health Chronic Care NP sees patient and system challenges and obstacles as opportunities for innovation and success. This person possesses the ability to work independently, remotely and has a passion to create a lasting impact on patient's lives and health.
\n
• Behavioral Health Chronic Care NP must have the ability to prioritize competing demands and promote a multidisciplinary team approach with strong problem-solving skills and attention to detail. The Behavioral Health Chronic Care NP is responsible for consistent operational compliance and reporting to satisfy and exceed state, federal and accrediting agency standards.
\n
• Must have experience developing and implementing new programs, which includes but is not limited to those which support the management of behavioral health patients with complex and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care to prevent re-admission and avoidable emergency service utilization. The Behavioral Health Chronic Care NP ensures that Members' medical, environmental, and psychosocial needs are optimized through the continuum of care.
\n
• Behavioral Health Chronic Care NP participates as needed in physician/hospitalist, daily and weekly operational, department meetings, Joint Operating Committee (JOCs) and MSO daily rounds meetings as delegated by the Medical Director or Population Health and Care Management Director. Behavioral Health Chronic Care NP assists Medical Director and Population Health and Care Management Director with the daily clinical operations, compliance, and oversight of programs. Participates as the liaison and contact for operational teams' members and is responsible for communication, coordination and monitoring of organization-wide chronic care initiatives and operations related to in/outpatient case management programs.
\n
• Plans, develops, implements, evaluates, refines care management intervention(s), and provide coaching and guidance to the Clinical Management staff for effective and efficient operation of behavioral health service, community care and other chronic care management programs.
\n
• Participates in the daily management of care and disease management functions, daily in-patient rounds, MSO in/outpatient high intensity rounds, home visits, social workers, palliative, hospice, and home medication therapy management programs. Interfaces with CRC and MSO Medical Directors and attends / participates in Interdisciplinary Rounds.
\n
• Works collaboratively with Medical Director and Population Health and Care Management Director to ensure compliance is maintained, identifies specialist issues, reviews re-admissions and avoidable admissions.
\n
• Coordinates provisions for complex ambulatory care (disease management, social services, behavioral health, palliative/hospice, health education, community resources, etc.)
\n
• Demonstrates consideration for the needs, clinical and financial, of the patients, payers, CRC clinical and partner MSO | IPA team members. Implement and support a culture of continuous quality improvement, regulatory and accreditation code of professional conduct, and the federal and state regulations on confidentiality, as well as all policies and procedures Prospect Medical Holdings Hospitals.
\n
• Coordinates the collaboration with patient's family and physicians for seamless coordination of care and services. Monitors and evaluates effectiveness of the chronic and end of life care management plan(s) and modifies as necessary to meet health plans and national standards (i.e., NCQA and DMHC requirements) for turn-around-time for assessments, care plans and Interdisciplinary Teams (IDTs).
\n
• Identifies and implements Initial Care Plan (ICP) by conditions identified in CCSPIP, patient assessment, medical records, authorizations/referrals, primary care physician, hospitalist, member, and interdisciplinary team. Works to develop patient prioritized self-management goals addressing both clinical and identified social drivers of health (SDOH) needs.
\n
• Create cases in the care management platform for each patient under care management with appropriate documentation including but not limited to cognitive function, ADL, environmental factors, psychosocial, medical history, medications, and benefits, etc.
\n
• Has the understanding and ability to escalate when situations present and need additional leadership intervention.
\n
• Develops and coordinates care plan and/or assessment findings with MSO/health plan care managers, and/or county behavioral health services/departments as appropriate to support the member's needs. Utilize available Health Information Exchange Systems (HIE) as available to maximize resources, and information available to develop a safe plan for each at-risk patient.
\n
• Manages a case load of chronic and high-risk patients in collaboration with Medical Director, Director of Population Health and Care Management as well as respective MSO/IPA partners.
\n
• Meets assigned / expected patient contacts daily to assess and coordinate care.
\n
• Complies and measures performance indicators, trends, and staff activity report relevant to CCSPIP, case management, disease management and other programs.
\n
• Analyze and manage the review of high-cost claims and coding review.
\n
• Develops workflows and processes to support care management operations
\n
• Develop the team objectives and goals with support to the organization and departmental strategic plans.
\n
• Ensures compliance is maintained with all health plan, state, deferral, and accrediting agency standard, e.g., NCQA/CMS regulations/delegation.
\n
• Expected to pursue ongoing education, certification, and self-development to remain current with industry standards and business objectives related to Behavioral Health Care Management.
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