Seeking a Licensed Practical Nurse to provide Chronic Care Management and Care Coordination to patients with multiple chronic conditions. The Care Manager is responsible for performing telephonic Care Management, including clinical assessments, patient education based on conditions, and early symptom identification. This role includes working with patients as well as resources provided to develop an ever-evolving and comprehensive care plan included but not limited to care coordination and referral services.

Responsibilities:

• Complete comprehensive care plans through chart review in specified time frames in alignment with policy/procedures
• Facilitate care coordination and perform all necessary chronic care management services to patients by continuously collaborating with Care Managers, Skilled Nursing Facilities, Physicians, Pharmacies, and other providers to meet the needs of all patients
• Make outbound calls to patients and other providers as indicated
• Schedule appointments as indicated
• Address patient concerns/complaints and report to leadership
• Apply critical thinking skills and problem-solving techniques to the chronic care management process
• Maintain current knowledge of disease processes, resources, and treatment options available
• Meet performance goals based on full-time hours
• HIPAA compliant use of computer access to facilitate patient care
• Use care plan to guide patient interaction and direction
• Complete all necessary documentation in the patient’s medical record in accordance with the practice’s charting policy
• Maintain active and valid licensure for the role

Requirements:

• Understanding of medical terminology.
• Understanding of documentation required for Chronic Care Management.
• Ability to understand and carry out written, oral and/or graphic instructions.
• Ability to multi-task, manage details and organize efficiently and effectively.
• Ability to interact with patients, medical and administrative staff, and the public effectively.
• EMR experience
• Intermediate proficiency with computers and telephone use
• Positive and proactive attitude; team player!
• Goal orientated
• Must be punctual and have reliable transportation
• Must have a valid form of certification and/or license in the state of Michigan
• LPN Compact License is preferred