DISEASE MGMT COMM HEALTH WORKER in Chicago, Illinois at Sinai Chicago

This is a Hybrid position. (3 days on site and 2 days remote). This can change at any given time due to department needs/demands. 1) Complete Health Risk Assessments along with diabetes, hypertension and depression assessments monthly. 2) Assist with community resources and social determinates of health 3) Enroll eligible members in disease management programs and provide disease specific & preventive care according to program requirements 4) Support the treatment plan prescribed by PCP's 5) Must maintain a minimum case load of 100-150 patients within 90 days of onboarding 6) Assist patients in scheduling appointments 7) Accurately documenting in MHN portal for each patient 8) Follow-up with members who have recently been in the ER and schedule 7-day follow-up appointments with PCP 9) Follow-up with members who have either admitted as an observation stay or inpatient stay and schedule 7-day follow-up appointments with PCP 10) Must be proficient in Excel 11) Must have excellent computer skills