Job Summary :
The Respiratory Disease Case Manager works collaboratively with primary care providers, specialists, and the health care team to provide case management services to members with COPD and Asthma and other chronic respiratory diseases, including, but not limited to, bronchiectasis and sequelae from neuromuscular disease on referral from providers.
Services include coordinating care and negotiating care plans with the member to empower them to effectively self-manage their respiratory disease.
Essential Responsibilities :
Conducts face to face and / or telephone visits and performs physical, psychosocial and educational assessments and develops, implements, evaluates and documents a care management plan, including disease severity, level of disease control, qualify of life and environmental control.
Provides extensive education, in laymans terms, about physiology and management of the members chronic respiratory disease.
Mutually establishes individual goal plan with the member guided decision making techniques. Determines effectiveness of treatment plan and the members abilities, limitations and barriers to self-management.
Works towards the goal of achieving optimal control and self-management of chronic lung disease under physician direction.
Assesses techniques and instructs patients in the use of medications and devices used for management of their disease. Provides education on respiratory disease and self-management to include environmental control and recommendations for environmental modification, tools and techniques to mobilize pulmonary secretions, methods for relaxation, energy conservation, and efficient breathing techniques, such as pursed-lip and diaphragmatic breathing.
Smoking cessation counseling, using motivational interviewing.
Evaluates the appropriate use and understanding of medications including actions, side effects, dosages and sequencing.
Recommends changes in regimen per protocol. Assess, titrate, and order O2 and other potential devices to mobilize secretions, adjust these, and prepare patients to use them effectively.
Performs basic pulmonary function testing and other testing as deemed appropriate per SOP or physician. Performs PFTs of quality equivalent to those in Pulm Lab and ABGs.
Interprets spirograms and ABGs by ATS standards subject to formal interpretation by Pulmonologist. Uses interpretations of spirograms and ABGs to guide therapy and to help patients understand their lung disease.
Establishes and maintains communication with other team members and departments to ensure procedures and systems function smoothly as well as promote continuity of care.
Consults with primary care provider or other referring providers as needed and provides regular updates on pt status. In collaboration with PCP and / or other referring provider, identifies and prioritizes strategies to guide member to achieve optimal respiratory disease control.
Coordinates or, where appropriate, makes referrals for specialists, pharmacy, social services, mental health, health education, diagnostic services, and community resources as necessary.
- Maintains data on members and utilization and results of the program to measure qualitative and quantitative outcomes. Prepares reports, proposals and documentation.
- Participates in establishing dept and program strategic goals, priorities and quality improvement efforts. Participates in updating P&P and in program development.
- Maintains appropriate documentation via KP Health Connect, RRS, and other information systems. Perform other duties as assigned.
Basic Qualifications : Experience
Three (3) to five (5) years of inpatient RT experience.
Education
N / A
License, Certification, Registration
- This job requires credentials from multiple states. Credentials from the primary work state are required before hire. Additional Credentials from the secondary work state(s) are required post hire.
- Respiratory Care Practitioner License (Oregon) within 6 months of hire
- Respiratory Care Practitioner License (Washington) within 6 months of hire
- Basic Life Support required at hire
Additional Requirements :
- QA / QI PFL experience.
- Computer operations, including PFT computers, word processing, email communications.
- Extensive knowledge of Pulmonary Function testing equipment, including troubleshooting, repairing, calibrations and QA procedures.
- Durable Medical equipment evaluations including drawing of arterial blood gages, use of oximetry.
- Effective patient and staff teaching / communication skills.
- Able to educate and train staff, collaborate with other depts.
- Able to perform quality assurance and quality improvements.
- Policy & Procedure development.
- Able to coach others and role model collaboration and teamwork.
Preferred Qualifications :
- RRT credential.
- AE-C credential.