Set team direction, resolve problems, and provide guidance to members of own team  Adapt departmental plans and priorities to address business and operational challenges  Clinically mentor/teach team members as appropriate under the direction of CSM  Maintain caseload of 50% or more patients and acquire patients according to team needs in conjunction with clinical advisor duties   JOB DUTIES:  The CA reports to and is supported by the CSM, CTL, or DCO Partner with the manager or supervisor to ensure effective on-boarding of new clinicians and ongoing development of existing clinicians  Develop innovative approaches and support the implementation and adoption of new clinical and quality initiatives  Does not have direct reports but works in coordination with the CTL, CSM, and/or DCO to enhance clinical expertise and adherence to the clinical model through planning and implementing the orientation and development of APC staff  Utilize advanced clinical nursing expertise, knowledge of geriatric/chronic disease management, and the long-term care industry to provide coaching, mentoring, and role-modeling to new and existing clinicians  Oversee and implement clinical staff development programs in collaboration with market leadership  Review work performed by others and provides recommendations for improvement in conjunction with supervisor  Serve as a resource to APCs/RNs for escalated complex and/or clinical issues  Partner with clinicians and other site functions to ensure business development activities are in place to meet business goals  Sought out as knowledge-based expert Communicate needs and issues surfaced by clinical staff to site and corporate leadership  Serve as a leader/ mentor   Promote the development of a collegial team, for coverage, troubleshooting and brainstorming  Foster and develop a culture of clinical expertise  Anticipate customer needs and proactively develop solutions to meet them  Solve complex problems and develop innovative solutions in collaboration with other stakeholders  Perform complex conceptual analyses   Forecast and plan resource requirements  Authorize deviations from standards  May lead functional or segment teams and/or projects  Provide explanations and information to others on complex issues  Motivate and inspire other team members  PRIMARY CARE DELIVERY: Deliver cost-effective, quality care to assigned members   Manage both medical and behavioral chronic and acute conditions effectively in collaboration with a physician or specialty provider  Perform comprehensive assessments and document findings in a concise/comprehensive manner that is compliant with documentation requirements and Center for Medicare and Medicaid Services (CMS) regulations  Ensuring that all diagnoses are accurate and support the documentation for that visit  The APC is responsible for ensuring that all quality elements are addressed and documented The APC will do an initial medication review, annual medication review and a post-hospitalization medication reconciliation Facilitate agreement and implementation of the member’s plan of care by engaging the facility staff, families/responsible parties, primary and specialty care physicians  Evaluate the effectiveness, necessity and efficiency of the plan, making revisions as needed  Utilizes practice guidelines and protocols established by CCM  May be required to participate in on-call program  Travel between care sites mandatory  After hour on call coverage may be required CARE COORDINATION: Understand the Payer/Plan benefits, CCM associate policies, procedures and articulate them effectively to providers, members and key decision-makers  Assess the medical necessity/effectiveness of ancillary services to determine the appropriate initiation of benefit events and communicate the process to providers and appropriate team members  Coordinate care as members transition through different levels of care and care settings  Continually monitor the needs of members and families while facilitating any adjustments to the plan of care as situations and conditions change  Review orders and interventions for appropriateness and response to treatment to identify most effective plan of care that aligns with the member’s needs and wishes  Evaluate plan of care for cost effectiveness while meeting the needs of members, families and providers to decreases high costs, poor outcomes and unnecessary hospitalizations  PROGRAM ENHANCEMENT EXPECTED BEHAVIORS: Regular and effective communication with internal and external parties including physicians, members, key decision-makers, nursing facilities, CCM staff and other provider groups  Actively promote the CCM program in assigned facilities by partnering with key stakeholders (i e : internal sales function, provider relations, facility leader) to maintain and develop membership growth  Exhibit original thinking and creativity in the development of new and improved methods and approaches to concerns/issues  Function independently and responsibly with minimal need for supervision  Demonstrate initiative in achieving individual, team and organizational goals and objectives  Participate in CCM quality initiatives    PROFESSIONALISM: Personal and Professional Accountability: Create an environment that facilitates the team to initiate actions that produce positive results  Ability to hold self and others accountable for actions and results in collaboration with CSM/CTL/DCO  Answers for one’s own behavior and actions  Career Planning: Develops own career path  Coach others in the development of their career planning  Ethics: Integrate high ethical standards and UHG core values into everyday work activities