Opportunities with American Health Network, OptumCare partner. When you join American Health Network (AHN), you become part of a team that strives to identify and retain the top healthcare professionals in the markets it serves. At American Health Network, we want to be the best health care organization we can be. Our mission is to improve the health of our patients. We’re a physician-led organization, operating over 70 medical offices in Indiana and Ohio, with over 300 providers and 1200 employees. We’re also an OptumCare partner, part of the UnitedHealth Group family of businesses, and backed by the resources of a global health care organization working to help people live healthier lives and help make the health system work better for everyone. That’s an important differentiator as more people need our help simplifying the complexities of the American health care system. At the same time, the culture of AHN supports work-life flexibility for providers and places a high value on their physical, emotional, financial and other aspects of well-being.
This position will be working face-to-face in clinic with patients at American Health Network's northwest Indianapolis and Zionsville practices. The schedule is Monday-Friday, 8am-5pm with some flexibility.
- Assesses the healthcare, educational, and psychosocial needs of the patient and their family at the initial referral to case management.
- Designs individualized plan of care with the patient and develops a team approach by working collaboratively with the family, primary care provider and other members of the healthcare team to ensure coordination of services.
- Monitors and updates individualized plan of care for the patient using a team approach by working collaboratively with the family, primary care provider and other members of the healthcare team to ensure coordination of services.
- Implements clinical interventions based on evidence based clinical guidelines.
- Identifies and coordinates referrals and other community resources.
- Follows appropriate care management protocols, as assigned by provider
- Implements system of care that closely monitors high risk patients to prevent / intervene early during acute exacerbations.
- Ensures therapies are arranged as directed by the practitioner and provides appropriate follow-up and monitoring as needed.
- Ensures medication reconciliation is completed and documented for all assigned patients according to Population Health guidelines.
- Performs patient follow-up calls for issues, feedback and continued follow-up needs, per care management protocol and recommended timelines.
- Assists with data collection and closing of care gaps and quality metrics as assigned and assists the healthcare team in meeting all of the quality metrics.
- Facilitates problem-solving with the patient/family to mobilize patient resources.
- Evaluates and refines the initial assessments and goal achievements in collaboration with the healthcare team.
- Advocates for patient/family in assisting the health care team in understanding patient’s rights.
- Works cohesively with the healthcare team in discharge planning to link patients with the most appropriate resources.
- Identifies opportunities for process improvement in all aspects of patient care.
- Attends meetings and participates on committees as requested.
- Reviews current literature and attends training sessions and seminars to keep informed of new developments in the field.
- Performs other related duties and responsibilities as directed.
- Understands and models AHN mission and UHG’s culture standards during all workplace interactions
- Participates and collaborates with other members of the Population Health Team and during Pop Health initiatives, to better care and meet the needs of our AHN patients.
- Current, unrestricted RN license in the state of employment
- Minimum of 2+ years of experience in a hospital, acute care or direct care setting
- A background in managed care
- Case management experience
- Certified Case Manager (CCM)
- Experience or exposure to discharge planning
- Experience in utilization review, concurrent review or risk management
- Previous experience in a telephonic role
Job Keywords: RN, registered nurse, certified case manager, case management, population health, managed care, Indianapolis, Indiana