As an ACO development expert, I have been asked to help design job descriptions for Care Navigators, Case Managers, and Disease Management Coordinators. Hiring for this role and its critical responsibilities is new for many physician-owned ACOs who know it when they see it, but often are stymied as what to write from a blank sheet of paper. I hope this will help.
Roles & Responsibilities of the ACO Disease Management Implementation Specialist
Reports To:
Senior Director, Medical Director, Executive Team, and Coordinates with Nurses and other medical technicians and specialists
Location:
Can be office-based, home-based, or contracted as a part-time independent contractor until the ACO finds the need to occupy their time for a steady 8-hours per day. We found that having the individual work from outside the office did not really impede the job function as long as communications technologies were able to handle call in meetings with webcast support to share reports, and participate face-to-face through video-enhanced VOIP calls into regularly scheduled meetings.
Job Summary:
The new hire can be assigned to be responsible for the implementation and project management of disease management programs in your accountable care organization, patient-centered medical home, large medical group, work-site health center, or as we used this specialist at Mercury Healthcare International’s Health Tourism vertical, to manage our case management for our medical tourism third-party administrator service bureau. We charged in the range of $125 per hour for this service through the TPA. That is a national average for disease management and case management services on an outsourced basis. The cost basis included work space, software licenses, workers’ compensation, professional development training costs, professional license and insurance insurance reimbursement, health insurance premiums, and other costs of employment, as well as mark up. An independent case manager working from home would not be able to market themselves at that rate in many cases, mainly because they don’t have the same overheads.
The responsibilities include, but are not limited to, managed care organizations, employer groups, physician hospital organizations, and multispecialty group practices. Areas of accountability include adaptation and implementation of disease management programs for a specific population, client, or disease group, and includes continuous internal and external client support and coordination of in-network and out-of-network resources with respect to disease management programs. The specialist will work in conjunction with the clinical pharmacy management team in clients with an existing clinical pharmacy management, polypharmacy evaluation, and coordination of multi-disciplinary care management teams and logistics for complex cases.
Reporting Relationship:
Organization specific
Principal Responsibilities:
- Manage the implementation and day-to-day operations of the organization’s disease management program.
- Identify patient and other internal and external customer needs and customize disease management programs to meet those needs with the guidance of the medical director, the Board of the ACO, and the executive team.
- Work closely with other areas including ACO program and services development, systems, outcomes research and reporting, claims management, and payer contracting to ensure customer needs are met while meeting internal objectives.
- Develop and manage the tactical plan for implementation of disease management programs. This includes development of timelines and documentation regarding the implementation process. The priority disease campaigns are often designated by the medical director and executive team, and typically influenced by cost and outcome reports centered on value-based healthcare purchasing objectives supplied by contracted payers or employers.
- Participate in disease management presentations to contracted payers and employers, and organize or present campaigns to targeted patients, depending on the size of the organization. (The role wears many hats in a smaller ACO.)
- Manage the activities of external agencies and team contributors and vendors /suppliers involved in the collaborative implementation of the program
Minimum Qualifications:
- Strong project management skills. Demonstrated ability to manage complex, multidisciplinary projects.
- Fully knowledgeable in GANTT chart use and design as a communication tool.
- Strong customer service orientation
- Detail oriented, with excellent verbal, written, interpersonal and presentation skills
- Cultural and language sensitivity and awareness
- Strong interpersonal and negotiation skills
- 4 years experience project management
- 4 years experience in nursing, the managed care or the pharmaceutical industry
- Computer skills including the Microsoft Office products
- Travel required
- A bachelor’s degree, advanced degree in health-care field or nursing preferred.
- Certification as a Case Manager from CMSA is preferred.
Often this role’s salary ranges from $35 to $45 per hour, plus benefits. One thing I’ve noticed is a willingness for nurses who are burned out from staff nursing in a hospital setting to be attracted to this role. Keep in mind that while the staff nurse position in a hospital is laden with physical stress on their feet all day, call-ins for vacant shifts, and other normal nursing duties, this desk job is much more stable, infinitely more interesting, and requires no overtime or call-ins. As a result, I’ve been able to hire for this role at considerably less per hour than a staff nursing position at a hospital or large medical group. In our current market, potential hires are more informed than ever about the market rate of their position’s salary. They weigh their decision based on salary, benefits, location, commute time, education programs and opportunities for advancement through easily accessible online data sources. To compete for talent, your organization must also know what the market is paying for certain skills and develop fair and reasonable salary ranges for the positions in your ACO, PCMH, IPA, PHO, MSO or other managed care organization.
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