Care Manager - RN, CMA, LPN or LSW

About the role

The Care Manager plays a crucial role in the medical home team, focusing on proactive care processes for clinic patients. This position involves facilitating communication, coordinating services, addressing barriers, and monitoring patient health.

Responsibilities

• Delivers team-based care in assigned clinics.
• Utilizes registries, electronic reports, and provider schedules to proactively assess and coordinate preventive screenings, care coordination, and communication.
• Maintains patient health status through the use of clinical evidence-based care guidelines and tracks interventions via EHR.
• Collaborates with team members to track, follow-up on referrals, and schedule appointments.
• Assists patients with education, support, and care coordination with external providers and community resources.
• Assesses patients' readiness to change, monitors compliance with treatment plans, and solves barriers related to healthcare systems, finances, and psychosocial factors.
• Uses behavioral strategies to help patients adopt healthy behaviors, improve self-care, and manage chronic diseases.
• Aids Outreach and Enrollment staff in verifying patient eligibility for Medicaid, SSI, etc., and coordinating enrollment with service agencies.
• Reminds patients of upcoming visits and coordinates Medicare annual wellness visits.
• Analyzes Medicare, Medicaid, and other payer reports and coordinates care accordingly.
• Collects, manages, and reviews data to develop reports for quality improvement programs.
• Participates in FHS meetings and committees as assigned.

Requirements

• RN, LPN, CMA, or LSW license required.
• Minimum 2 years of experience in health, public health, or social service, with an emphasis on community and population health and care coordination.
• Fluency in written and spoken English; bilingual English/Spanish preferred.
• $19.00 - $32.25 per hour DOE, with the possibility of a $520 quarterly bonus.
• Excellent organizational skills, strong written and verbal communication, strong computer skills, particularly in Microsoft Office, and EHR experience preferred.
• Ability to build and maintain effective partnerships internally and externally, with awareness of community resources.
• Ability to work with patient/client groups and/or experience in membership organizations.
• Ability to work with minimal supervision and maximum accountability to problem-solve and work independently and collaboratively as a member of a team.
• A professional demeanor, pleasant manner in telephone and personal contacts.
• Analytical skills with the ability to manage and prioritize multiple tasks.

Qualifications

Prefer 2 years of experience in the fields of health, public health, or social service; an emphasis on community and population health and care coordination is desirable. Fluency in written and spoken English; bilingual English/Spanish preferred. Employee's can receive up to $520 on the quarterly bonus. Knowledge, Skills, And Abilities Required: Excellent organizational skills and strong written and verbal communication skills. Strong computer skills, particularly in Microsoft Office. EHR experience preferred. Ability to build and maintain effective partnerships internally and externally with an awareness of community resources. Ability to work with patient/client groups and/or experience in membership organizations. Ability to work with minimal supervision and maximum accountability to problem-solve and work independently and collaboratively as a member of a team. A professional demeanor, pleasant manner in telephone and personal contacts. Analytical skills with the ability to manage and prioritize multiple tasks.