My name is Aaron and I spent the last three years in case management for two different companies. I spoke with the Project Management Institute about my work and they stated that my work could qualify as project management related work for application. I wanted to see if how I described my positions is appropriate for the application.
1. Federation of Organizations is a non-profit healthcare organization that partners with different healthcare organizations to promote cost efficient and effective results using a variety of services. I was case manager for the organization in their effort to help the Hudson River Health Home. My official title was called a “care coordinator”. The goal was to lower healthcare costs for the organization by keeping them healthy in the community rather than hospitalizations or expensive outpatient services. My job was to evaluate each case’s needs and address them. Care plans were created based on needs and when all the goals were met on the care plan, I would close the case knowing the member was more stable in the community. These goals included connecting clients to doctors or other medical services, locating financial resources, monitoring daily health habits, finding housing resources, and whatever else was keeping them from stability in the community. Healthcare expanded to have realized proactive approaches save the system money and better the health of our patients. Cases were opened and closed depending on each case need, but the average case was opened for about a year. The financial capital saved was unknown to me as I was not in the financial department, but through the efforts done by my case management, knowing what we know about healthcare today, it was thousands of dollars, which is the whole purpose of the case management service at Federation of Organizations. However, I do not have access to the exact savings, since a was only a case manager. I had led the projects that I was assigned. Each patient was considered a project and I had about 50 patients at a time. Below are the project deliverables summarized by each stage of the project management cycle.
Initiating: I conducted an initial assessment with each client and from the assessment, their care plan was drawn up based on variables that contributed to their poor health status and all the outcomes that come with it.
Planning: A care plan based on needs was drawn up. Case manager and client are given a responsibility in making sure the client achieves the goals. This is discussed with the client right after the assessment.
Executing: Case manager has telephonic or in-person follow up with the client to assure that they are completing their responsibilities in the care plan daily. Case manager also follows through on assignments based on care plan need and updates client during monthly telephonic follow up.
Monitoring: Progress is monitored and documented through electronic health record and adjustments are made if client has set back in their health.
Controlling: Once initiatives are put into place and it is seen that there is a positive effect on client. Positive effect means client is healthy in the community and has not been going to the hospital or needing high-cost outpatient treatment, case manager will work to make sure client is consistent in maintaining achieved goals.
Closing: Case is closed if all goals are met and client is stabilized regarding health. One sign of this is client improves in health condition so much that they have been admitted to hospital since working with care coordinator. This is a sign that finances are being saved and the client is healthier.
2. UnitedHealth Group is an organization that is a merger between Optum Health Services and UnitedHealthcare health insurance company. In my role, I was a case manager for the Optum side of the company, and I would work with the UnitedHealthcare members. My official title was called a “Community Health Worker”. I was a case manager that lived and worked in the community that the members that were assigned to me lived in. My job was to call certain members of the insurance who were recently hospitalized or use the top 15% of the insurance company’s money and enroll them in our case management program. From that point, I would walk them through an assessment that identified barriers in their healthcare that had caused their decline in health and in certain circumstances hospitalization. Hospitalization is the costliest bill the insurance company can receive, so that was my top priority to address. From those barriers, a care plan is created that the member agrees to. The case manager and member both have roles in the care plan. Goals may include connecting clients to doctors or other medical services, locating financial resources, monitoring daily health habits, finding housing resources, and whatever else was keeping them from stability in the community. Cases were opened and closed depending on each case need, but the average case was opened for about three to six months. The capital that was saved in the efforts were unknown to me as a case manager, but hospitalizations cause thousands and each member that I had brought to stability in the community after hospitalization or expensive outpatient services were worth thousands of dollars in savings for the insurance company. I had led the projects that I was assigned. Each patient was considered a project and I had about 70-100 members at a time. Below are the project deliverables summarized by each stage of the project management cycle.
Initiating: I call the member and convince them to enroll with the case management program that comes with their insurance. UnitedHealth Group’s investment in our salary and resources were the cost of saving the insurance company money in unnecessary healthcare bills. I conducted an initial assessment with each client and from the assessment, their care plan was drawn up based on variables that contributed to their poor health status and all the outcomes that come with it.
Planning: A care plan based on needs was drawn up. Case manager and client are given a responsibility in making sure the client achieves the goals. This is discussed with the client right after the assessment.
Executing: Case manager has telephonic or in-person follow up with the client to assure that they are completing their responsibilities in the care plan daily. Case manager also follows through on assignments based on care plan need and updates client during monthly telephonic follow up.
Monitoring: Progress is monitored and documented through electronic health record and adjustments are made if client has set back in their health.
Controlling: Once initiatives are put into place and it is seen that there is a positive effect on client. Positive effect means client is healthy in the community and has not been going to the hospital or needing high-cost outpatient treatment, case manager will work to make sure client is consistent in maintaining achieved goals.
Closing: Case is closed if all goals are met and client is stabilized regarding health. One sign of this is client improves in health condition so much that they have been admitted to hospital since working with care coordinator. This is a sign that finances are being saved and the client is healthier.
Thank you in advance for your assistance. Any feedback is greatly appreciated!
Aaron Erdman
Saving Changes...
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