<aside> đź’ˇ A standard operating procedure (SOP) is a set of step-by-step instructions compiled by an organization to help workers carry out routine operations. SOPs aim to achieve efficiency, quality output, and uniformity of performance, while reducing miscommunication and failure to comply with industry regulations.

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Document Purpose

This policy is to streamline the work flow of NMM’s Nurse Advise Line to serve members who are enrolled in Enhanced Care Management program.

Document Scope

Network Medical Management (NMM) and its affiliated entities, globally referred to as “NMM” shall follow the procedures set forth in this policy.

This is especially for Ambulatory Care Management Team’s Case Manager position.

Definitions and Acronyms

Term or Acronym Definition or Meaning
ECM(Enhanced Care Management) Enhanced Care Management is a statewide Medi-Cal benefit available to select members with complex
needs. Enrolled members receive comprehensive care management from a single lead care manager who
coordinates all their health and health-related care, including physical, mental, and dental care, and social
services.
NAL Nurse Advice Line
Talkdesk Talkdesk is a cloud-based call center solution that helps businesses improve customer satisfaction while simultaneously reducing customer support costs.
LCM(Lead Care Manager) A LVN or RN who are part of the ECM team.
ECM Director A staff who is responsible to manage multidisciplinary care team, quality measures and reporting for ECM team
ECM Clinical Consultant A clinician who is responsible for ensuring clinical assessment elements leading to the creation of the plan of care are under the direction of an independently licensed clinician. Act as clinical resource for care team, as needed. Facilitate access to primary care and behavioral health providers, as needed to assist care coordinator and team.
CHW Community Health Worker
WC Wider Circle

The Process Steps

  1. All LCM and ECM Director have a Talkdesk account. Talkdesk will be able to keep a record of the call history and record the conversation for quality measures.
  2. On-call hours includes:
    1. Weekday 5pm to 8am
    2. Weekend
    3. Holiday
  3. Schedule for on call LCM will be created and sent by the end of each month.
  4. A resource sheet will be provided to all the on-call nurse as a reference.
  5. On-call LCM will
    1. log into Talkdesk at their shift
    2. document all the calls including member’s questions and recommendation provided to member.
    3. Send report to ECM direct by the end of their shift
  6. When a call comes in, on-call LCM will
    1. verify member’s name, date of birth
    2. locate member in the care management system and verify if member is currently in ECM program.
    3. Actively listen to member’s concerns and questions.
    4. If a member has non-clinical questions, provide the answer or advise someone will call member back within the next business day.
    5. if a member has a clinical question,
      1. When ______ advise member to go to ER immediately.
      2. When ______ advise to contact their PCP office the next day.
      3. When_______ advise to

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