Title: RN, Complex Care Management Purpose: Provide consistent and systematic documentation of all contact with Complex Care Management cases. Scope: Complex Care Management referrals, encounters, enrollments, communications, assessments, care plans, medications, and all related clinical and non-clinical information entry and storage. Process: Referral Received and either accepted, outreached, and enrolled, or declined: 1. Search member last name or ID number at top of screen 2. Click on blue member ID number hyperlink 3. Click Care Management on left side 4. Under Referrals to Care Management at bottom, click Add a. Enter Contact Name, Contact Phone, and Contact Email if available b. Assigned to: select self c. Referral Source: select source ( Claims Data for vquest) d. Referral Date: select date e. Referral Status: i. Open if need to validate that case is complex, or if member is eligible ii. Decline if not going to outreach to patient (deceased, ineligible, not complex, etc ) iii. Accept if going to outreach to patient iv. Select program to enroll: Outreach v. Click Save 5. Click Care Management again on left side 6. Click blue Outreach hyperlink under Current Enrollments a. Program: Outreach b. Manager: select self c. Specialist: enter patient s phone # or other important information d. Nurse: enter policy # or insurance name or other important information e. Start Date: enter date referral received f. Preferred Language: enter GL CCM Process Documentation FINAL 2.27.15 1
g. Acuity Level: Intensive h. Diag Code: Click magnifying glass to search for diagnosis, then click on blue # hyperlink or enter code i. Click save 7. Call Member, explain program, enroll if agreeable, and agree on face to face visit date and time. 8. Click Add under Encounters a. Encounter date: Add date spoke with patient b. Results: Select Encounter Type from pick list (Member Outbound Call) c. Notes: enter notes describing the encounter 9. Add Task if determined b. Type: Complete (or Schedule) Face to Face c. Assigned To: Select self d. Due date: enter date needs to be done e. Notes: enter notes describing the task if needed f. Click Save g. Click Save & Close 10. Under Enrollments: a. If member does not agree to enroll in CCM, General CM, or unable to reach: i. End Date: enter date member declined CCM or General CM, or 3 rd unsuccessful call ii. End Reason: enter reason (Patient refuses CM, Unable to Contact ) iii. Click Save & Close iv. See #15: send out Termed Member letter for those unable to be reached b. If member does agree to enroll in CCM or General CM i. Click on button: Move to Program ii. Select program: Complex Adult Care Management **(see note below) iii. Click Select This Transfers the Outreach Enrollment to the CCM Program Enrollment Page! **Note** if member is not truly complex but needs general case management, move to program: General Case Management. 11. Click Care Management on Left GL CCM Process Documentation FINAL 2.27.15 2
12. Under Current Enrollments: a. Click on blue Complex Adult Care Management or General Case Management link b. Program: Complex Adult Care Management or General Case Management c. Manager: Select self d. Specialist: Type member s phone # (or other important information) e. Start Date: Enter date member agreed to enroll f. Preferred Language: enter language g. Acuity Level: Intensive h. Click Save 13. Under Encounters: Add Encounters to document all calls to member and provider a. Encounter Date: Enter date b. Result: Enter Encounter type (Member Outbound Call etc.) c. Notes: Enter relevant notes/description of encounter 14. Add Tasks: b. Type: select task (Complete Face to Face or Phone Call, etc) c. Due Date: select date d. Assigned To: select self e. Enter applicable notes in free-text field f. Click Save g. Click Save again and h. Pop up box: click on the box for any tasks that need to be closed i. Click Close To send out Intro Letter or other letter to patient: 15. Under CM Letters and Notes: a. Select a letter to open: select letter type (Intro Letter, Termed Member, etc) b. Click Open Letter c. Select a Format: select a format to export to (Word or PDF) d. Click Export. Will open a word or PDF file e. Edit Word document and save in shared folder GL CCM Process Documentation FINAL 2.27.15 3
16. Under Attachments: b. Click Browse c. Select document in shared folder and click Open d. Click Save 17. Mail letter, fax letter, or email letter 18. Document communications under Communications Tracking: a. Click Show b. Under Communications History, under Add Record: i. Shared Date: Enter date letter was sent ii. Sent To: Select (Member, Provider, or Caregiver with consent iii. Topic: Select topic iv. Share Method: Select method v. Language: Select language vi. Enter relevant notes in free-text field vii. Click Submit Perform home visit assessment on date scheduled: 19. Under Enrollments: Click blue Complex Adult Care Management link 20. Under Encounters, click the blue number link under Item 21. Click the box next to Assessment a. Answer each question based on member s answers, click Next b. May click Close box at any time to exit assessment. This automatically will save progress. CCM may return to assessment at a later time. c. At the end of assessment, click Save 22. Click the box next to Quality of Life, repeat a through c under #21 23. Under Problems List: a. Review each patient assessment-generated Problem b. Delete erroneous Problems: click on yellow pencil icon c. Click on each blue number under Item i. Note: enter relevant notes here GL CCM Process Documentation FINAL 2.27.15 4
ii. Interventions: add/modify interventions here iii. Under Goals List: 1. Review each Goal 2. Delete erroneous Goals: Click on yellow pencil icon 3. Click on each blue number under Item a. Under Goal Edit: i. Target Date: Enter when Goal to be completed ii. Complete Date: Enter when completed iii. Goal Desc: Can modify, search for new goals iv. Priority: Select priority v. Status: Select status vi. Member Engaged: Yes if member agrees with goal vii. Note: enter relevant notes b. Click Save & Close 4. Click Save & Close after each Goal addressed with patient d. Click on Save & Close after each Problem addressed with patient e. Pop up box: click on the box for any tasks that need to be closed f. Click Close 24. Under Member Care Team: Click Show b. Fill in all Contact boxes c. Click Add for each new care team member d. Click Save 25. Scroll up and click blue Medications link on left b. Enter medication information in all fields c. Click Save & Close 26. Review Problems, enter Interventions, update status on Goals, and enter new Encounters GL CCM Process Documentation FINAL 2.27.15 5