SCE
When a member goes back into the hospital in the middle of a significant change event, what is your next step?
do a new discovery form
How many high’s for priority can we have on a care plan?
What is 1
Do you have to mail UTR and CMR care plans to the PCP and member?
no. but you do notify external care provider
If a member has SRS, how many goals in the care plan should they have
2
What should be checked daily to see if you have any pending activities or members that need addressed?
Request received widget
What script do you ALWAYS complete for a SCE- whether you reach someone or not?
Significant Change Event Discovery
Where in the care plan do you put the deferred goal rationale?
What is general considerations
How many days do you have to complete an HRA on a new member?
90 days
When reviewing service plans for SRS members, how many hour/ units are approved for Care Star?
2.125/8.5 units
When does the ICT letter need to be mailed to the PCP?
7-45 days prior to planned meeting
What type of letter do you send to the PCP when a member has an ER visit?
What is FI transition notification letter
When updating the care plan, what do you put in the progress notes?
What is
Progression
Barriers
Continuation
Timing
If a previously active member is now UTR, what do you do with the other goals?
Put them on hold
What is the timeline an SRS member has to stay in contact with their Recovery manger before losing their benefits?
90 days
Where can we find new members assigned to our caseload? In population health, under my members
In population health, under my members
If you’re a SW, what should have completed for your RN?
What is Updated meds and DC instructions, fax number of PCP office
When goals are automatically generated how does “recommended” goals have to be addressed?
What is Deferred or accept goal
What risk stratification should a UTR or CMR member be set at?
Low/monitoring
If a recovery manager emails you, are you allowed to email them back?
no
Barriers and strengths should be addresses at minimum how often?
Yearly
What script do you complete if you get a hold of member for an ED visit?
What is ED diversion script.
If in the HRA, the member indicates a main health concern, what should we do?
What is care plan it
What scripts are required during a semi-annual visit?
MyCare Face to Face script v5
Where should all assigned Recovery managers be documented in the member's chart?
In the care team
What are the 4 main scripts to complete on an annual?
OH HRA v2 2. MyCare F2F v5 3. MyCare PLOC 4. Emergency response plan