Chronic Care Manager (CCM)
: Job Details :

The CCM Care Manager will be responsible for the coordination of the patients care and services. Promotes quality care using a collaborative process that coordinates, monitors and evaluations services according to the needs of patients. Perform chronic care management while working together with the patient and famil, care teams, payers and external entities to promote a safe transition from the facility to the next provider or care setting in accordance with all applicable laws, regulations, and Richmond Health Network standards. Assist with special projects in the Population Health Department as needed.Key Responsibilities:- Demonstrates excellent active listening, written and verbal communication skills.- Excellent organizational skills and be efficient in prioritizing and managing time and assignments.- Contribute to the organization's goals and objectives.- Provide ongoing education to help patients better manage their chronic illnesses.- Ability to work with minimal supervision, with a self-starter mentality.- Demonstrate problem-solving skills and a can-do attitude.- Electronic Medical Record (EMR) experience; complete all required documentation in the EMR; making teams aware/collaborating throughout multiple applications simultaneously.-Strong assessment and critical thinking skills with impeccable attention to detail.- Provides compassionate care to a wide diverse population.- Outreach to patients to confirm diagnosis, contributing factors, anticipated treatment plan, current and projected functional ability, and barriers to care.- Review patients enrolled in care management each month to ensure treatment goals are met and the care plan is shared across the care teams.- Identify patients who are at risk for high utilization and determine possible supportive service programs.- Track patients who have had a recent ER visit, hospital adminission, or inpatient procedure and reach out to provide supprt, maintain continuity of care between hospital and PCP (Primary Care Provider), and reduce risk for readmission.- Must work with multiple departments, agencies and third-party clientele to provide first-class patient care.- Assist with value-based programs and quality initiatives.-Maintain detailed recoards of communications with patients.- All other assigned tasks.Education, Experience and Licensure Requirements:- Bachelors Degree required; in a health-related field preferred- Graduated from an accredited medical assistant program- Must maintain an active National Certification as Medical Assistant in good standing throughout employement- Basic Life Support for providers through the American Heart Association is required.- At least 1-3 years of healthcare experience with direct patient care- Prior case management, utlization review and discharge planning experience preferred.- Microsoft office suite.Salary Range: $50,000 - $55,000