Workflow
What are the HIPPA identifiers that are to be used during every outreach, and how many are mandatory?
Name, DOB, address, member ID
Must have 3 identifiers
COS door to door requests should be sent in Jiva for which enrollees?
High PICS, inpatient referrals, top 1%, or based on clinical judgment
What platform do you access to send HIPAA compliant text messages to enrollees?
HealthCrowd
What is the current policy for unplanned PTO or alternate work location request?
Email direct supervisor and manager
At the Maine Ave location, how many conferences rooms are available for use?
3- Executive, Large, Small
What is the timeframe from identification date to first outreach?
1. Within 1-3 business days of receiving the referral for PICs top 1%, inpatient admits, priority populations, and urgent referrals
2. Within 5 business days of receiving the referral for routine referrals.
Who is the manager of Utilization Management?
Melissa Wallace
After verifying an enrollee has successfully or unsuccessfully accessed a community resource, what platform is used to documented a closed loop referral?
FindHelp
What is the same day requirement prior to a scheduled case management face to face engagement?
On the day of the visit call the enrollee to confirm appointment
*Per SOP ICTM F2F
Name two opportunities and activities for enrollees made available through the Wellness Center?
What is the one mandatory goal in a Care Coordination plan of care?
General Care Coordination Pathway
Who is the ACDC Medical Director?
Dr. Kevin Wheeler
What platform is used by leadership team for call monitoring and real time monitoring?
Verint
What is the next step for a Care Connector/ Peer Recovery Specialist who receives a death notification from a family member or caregiver (multiple steps)?
Associate offers bereavement services and community resources as appropriate.
Associate adds “Sensitive Note” about the enrollee’s death (date) in JIVA.
Associate sends email (date of death, name, Member ID) to the IHCM/Population Health/COS Supervisor and Manager.
Supervisor or Manager completes the Quality Indicator Assessment.
What ACFC staff member do you notify via email if an enrollee has moved out of state?
Shelly Thompson
What is the timeframe before an episode is considered overdue, both Care Coordination and Complex?
Care Coordination- 6 months
Complex CM- 12 months
What ACFC team will support enrollees with finding in network providers, booking appointments, and connecting to community resources?
Rapid response outreach team (RROT)
Which platform is utilized to review pharmacy claims?
Darwin
What is the name of the guiding ACFC document that ensures secure use of PII and PHI?
Acceptable Use Policy
How are documents translated into large print, or audio recordings for our visually impaired enrollees?
Email ACSI at production@acsitranslations.com
What assessment needs to be completed for every Complex episode within 60 days of identification date?
Disease specific assessment
Who would you contact with any facilities related concerns for the office at Maine or the Wellness Center?
Hermilo Estrada (Milo)
Which platform is used to manage and review retirement benefits?
Empower
As outlined in the Acceptable Use of PHI policy, we must obtain a written authorization signed by the member prior to disclosing PHI. What platform is used to obtain written consent?
Consent Management
What are the 3 motivation and morale initiatives are being implemented in 2025 for the Population Health Team?
- Wellness Room
- Lunch and Learns
- Quarterly Team Outings