AI prompts for care managers

Attached is today's discharge export from [hospital or ADT feed name]. List every patient attributed to our practice who was discharged from an inpatient, observation, SNF or rehab stay. For each, show discharge date, facility, discharge diagnosis, PCP, phone and the deadline for interactive contact: 2 business days after discharge, skipping weekends and [our holidays]. Sort by deadline, earliest first. Flag anyone already past it.

Attached is our TCM tracking log for [month] with discharge date, each contact attempt (date, time, method, outcome), face-to-face visit date and planned TCM code. For each patient, check two things: interactive contact within 2 business days, or 2 or more separate unsuccessful attempts made in time; and a face-to-face visit within 7 days for 99496 or 14 days for 99495. List every patient who fails a check and which check. Don't change any codes.

Attached is our problem list export for active Medicare patients and our current CCM enrollment roster. List patients with two or more chronic conditions from this list: [hypertension, type 2 diabetes, COPD, heart failure, CKD, depression]. Group by PCP. Show each patient's qualifying conditions, last visit date and preferred language. Exclude anyone already enrolled. Tell me how many you excluded and why. This list is for clinician review before outreach.

Attached is our CCM time log for [month] to date. Total clinical staff minutes per patient. List patients under 20 minutes, sorted by minutes remaining, with assigned care manager and last contact date. There are [number] business days left in the month. Suggest a daily call target per care manager that gets the most patients past 20 minutes. Show your math.

Attached are [patient initials]'s last three visit notes, current medication list and most recent discharge summary. Write a pre-call brief under 120 words: active problems, medication changes in the last 90 days, open referrals, pending labs, and anything the patient said they'd do at the last visit. End with three questions to ask on the call. Name the source note for each item.

Using the attached visit note, problem list and medication list, draft a care plan for [patient initials]. For each problem, give: the goal in the patient's words, a measurable target, barriers, interventions, who's responsible and a review date. Add a section on caregivers and community supports, with [brackets] wherever the notes don't say. Then write a one-page patient version at a sixth-grade reading level. Leave blanks rather than guessing.

Compare the attached hospital discharge medication list with our current medication list for [patient initials]. Make three lists: new medications, stopped medications, and dose or frequency changes. Flag possible duplicates in the same drug class. Write the questions I should send the PCP or pharmacist. Don't recommend which list is correct.

Attached is the [payer or ACO] claims or ADT file for the last [90] days. List patients attributed to us with [2] or more ED visits in that window. For each, show visit dates, facilities, primary diagnoses, PCP, last PCP visit and whether they're enrolled in care management. Sort by visit count, highest first. Flag anyone with no PCP visit in 12 months.

Attached is our remote patient monitoring export for the last [7] days. List patients with no readings in [3] or more days, and patients with any reading outside these parameters: [e.g., systolic BP over 160 or under 90; weight up 3 lb in one day]. For each, show the readings, dates and assigned nurse. Put out-of-range patients first. This list is for nurse review only.

Attached is our caseload export with patient, assigned care manager, program (CCM, TCM, [other]), risk tier and last contact date. Show each care manager's patient count, high-risk count and patients with no contact in [30] days. Propose a rebalanced assignment that evens out high-risk patients, keeps patients with their current care manager where possible, and keeps Spanish-speaking patients with [name]. List every proposed move.

Write a short phone script for re-engaging a care management patient who missed their last two scheduled calls. Open by naming [practice name] and [care manager name]. Ask how they're doing, explain what the program does for them in one sentence, and offer two call times. Add a voicemail version under 30 seconds. Write both in English and Spanish. Warm and natural, not scripted-sounding.

Write a one-page handout for patients with heart failure about daily weights: why it matters, how to weigh (same time, same scale, after urinating, before breakfast), what to write down, and when to call us: [our weight-gain threshold]. Use a sixth-grade reading level. Add three teach-back questions for the care manager. Then translate it into [Spanish].

Attached is our community resource spreadsheet for [county]. Build a one-page referral guide grouped by need: food, transportation, housing, utilities, behavioral health and caregiver support. For each resource, list name, phone, hours, eligibility and cost. Flag entries with no verified date or one older than [12] months. Use only what's in the file.

Attached are our care management logs for [month]: the CCM time log, TCM log and enrollment roster. Report patients enrolled, new enrollments, disenrollments with reasons, patients at 20 or more CCM minutes, TCM discharges, TCM contacts within 2 business days, and TCM visits completed within 7 and 14 days. Compare each to last month. Write a five-bullet summary with counts only and no patient names.

Attached are my caseload export and my last two weeks of care management notes. Write a handoff for [covering care manager] for [dates]. For each patient with an open task, a scheduled follow-up or a recent discharge, give two lines: what's going on and what needs to happen while I'm out, with dates. Put anything time-sensitive at the top. Skip patients with nothing pending.