Outpatient Case Management is responsible for making sure referrals get sent outside of the YK system as well as making sure information coming back is managed according to patient needs. We have a family medicine case manager for each of the three clinics, as well as two pediatric case managers. Women's Health has a GYN case manager, prenatal case manager, and Breast/Cervical case manager. We case manage for our Outpatient providers, ED, as well as all SRC’s.
The Inpatient Case manager is responsible for Inpatient patients, Surgery (CS/EGD only), as well as Dental OR case management.
General Outpatient Case Management
Pediatic Case Management
We have two case managers and two case management assistance to assist with all case management of our 1,200 chronically ill patients. There are a number care management issues we can handle ourselves easily and then there are many things that we need our care manager’s help with on a regular, urgent and emergency basis. The case manager is an excellent resource, but we need use this valuable resource carefully to prevent burn out.
Below is a list of CM duties and things that they can do/assist with. If you place a referral for a patient in Raven you need to also send a patient communication to the case manager letting them know the referral order was placed. If you need something urgently, you can call, email or walk to the office to see the care manager to ask for help.
Chronic Pediatric Patient (CPP) Case Manager Duties
1. First point of contact for families. This includes education, translation of medical terms, lab results, interfacing with supply companies when needed and act as an liason with Medicaid and other insurance companies. Contacting MD’s when appropriate with any patient questions or concerns.
2. Send Referrals placed by MD’s (either via Raven, AFHCAN or by FAX), and remove from Multipatient Task List.
3. Receive Dictations from outside Provider’s and or Hospitals, read over and scan to patient chart. Let appropriate MD know of any changes that have been made. Propose meds, referrals, labs, etc…to appropriate provider when needed.
4. Receive abnormal lab values and f/u with appropriate provider any recommendations. Call family to give results and education when applicable. Ex – Elevated CPT1 – alert MD that dx needs to be added to pt Problem List and call family to educate about dx. Propose any repeat lab that has been recommended.
5. Scheduling Appointments – the CM has access to scheduling slots we might not have,
6. Scheduling Field Clinics – CPP CM is responsible for scheduling all Pediatric Field Clinics. This includes: Pulmonary three to four times yearly, Endocrinology three times yearly, Cardiology four times yearly, and Neurology two times yearly. Requires coordinating dates with each Specialty, then scheduling patients for each clinic. Also, requires setting up lodging and travel for specialist, and ensuring clinics run smoothly.
7. Phone Calls – This can take many hours daily. Patients call for a variety of issues. Ex - checking on status of referrals, med refills, needed appointments, insurance issues… Also, many CM’s from outside specialties call for needed documents, requested appointments, patient updates, travel issues or a variety of other issues.
8. Making new patient charts – Any babies born outside of YK need a chart made. This requires filling out a sheet with information about patient and patient’s family and taken to registration. They complete the process, then any needed appointments can be made and or notes from outside facilities can be saved to pt chart.
9. Patient Travel – When patients have appointments, travel must be made. If pt lives in the village – appointment letters are faxed to VC so the HA can set up travel. If pt lives in Bethel — a VTO must be completed and taken to Travel Office with a copy of appointment letter. Calling Admin on Call to get travel approved for patients that do not have Medicaid when necessary.
10. Medicaid Letters – Medicaid frequently requires more information on patients, and a plan of care letter must be written and signed by MD so travel will be allowed. Also, some patients require two escorts and a letter must also be written so Medicaid so they can determine if it is medically necessary.
11. CMNs – These are prescriptions to supply companies (Geneva Woods, Procare). Must be done for all supplies and signed by an MD yearly. Ex – Incontinent supplies, formula, G-Tube Supplies, Thick-It….