KEY POINT HEALTH SERVICES, INC.

ANNUAL EVALUATION

EMPLOYEE: ______SUPERVISOR(S):______
JOB TITLE__Program Manager PRP COP RRP ______
DATE______

SITE LOCATION:______Employee ______1

Key Point Health Services, Inc.

Annual Evaluation based on

Job Description for Program Manager(PRP/COP/RRP)

Employment Date: ______

Position Title: Program Manager

Job Responsibility / Outstanding* / Highly Effective / Effective / Needs Improvement** / Unsatisfactory**

*Requires Clarification in Comments Section ** Requires Clarification and Improvement Plan

The Program Manager is responsible for:

  1. the comprehensive services offered through on-site and off-site programs. This includes
  2. assessment,
  3. case management,
  4. psycho-education,
  5. crisis intervention,
  6. advocacy
F. and as a community liaison. / ______
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2. for the preparation of patients’ records for internal and external audits, as well as submission for authorizations. / ______/ ______/ ______/ ______/ ______
3. adhering to standards and regulations as set forth by the agency, and COMAR; / ______/ ______/ ______/ ______/ ______
4. responsible for all administrative tasks as well as clinical supervision of each employee. / ______/ ______/ ______/ ______/ ______
5. The program manager is responsible for the training of new employees and the supervision of the program in the event the program director not available. / ______/ ______/ ______/ ______/ ______
6.able to work independently and be proficient in resource development. / ______/ ______/ ______/ ______/ ______
7. abiding by all safety rules and regulations of the department and facility; / ______/ ______/ ______/ ______/ ______
8. carrying out the mission, philosophy of care and policies of Key Point; and / ______/ ______/ ______/ ______/ ______
9. performing other duties as needed to achieve program goals and objectives / ______/ ______/ ______/ ______/ ______

PART III - CORRECTIVE PLAN/PROFESSIONAL DEVELOPMENT

PROFESSIONAL DEVELOPMENT (Comments required for * and **):

IMPROVEMENT PLAN (Required for **):

PART IV - EMPLOYEE & SUPERVISOR COMMENTS

EMPLOYEE COMMENTS:

An employee may use this to document agreements or disagreement with the appraisal report, and offer suggestions for improvement in the job, or make other comments, if desired.

SUPERVISOR COMMENTS:

By my signature, I acknowledge that my supervisor and I have discussed this progress report and my employee comments indicate my agreement/disagreement.

Employee Signature: ______Date: ______

Supervisor’s Signature: ______Date: ______

Director’s Signature: ______Date: ______

10/2007 revised

Site Location ______Employee______