Care Manager - Chicago, United States - Primecare Community Health

Description

Job Description

This position is eligible for hybrid work schedule: 2 remote days/week

Position Summary

The Care Manager is responsible for coordinating, screening, and providing care management to

empaneled patients with identified complex chronic care and behavioral health needs. Addresses

patient needs by providing care management and other resources. Provides guidance and

leadership to other care team members ensures the patients receive the best possible care.

The Care Manager provides patient guidance and support through regular conversations, care plan

development and goal setting, and patient education regarding diagnoses, health, goal progress, and

referrals to internal and external resources as necessary. As a member of the Care Management

team, each member shares knowledge and ideas to assist patients to meet goals and improve health.

Duties and Responsibilities Nurse Care Manager:

1. Identification and tracking of high-risk patients with care coordination and oversight via:

• Comprehensive risk assessments.

• Integrated patient care plans focusing on disease self-management.

• Ongoing clinical assessment, monitoring and contact.

• Assessment of behavioral health needs, working with Behavioral Health Care Coordinators in

identifying community or internal/external agencies, resources and programs.

2. Promote clear communication amongst team members regarding patient care plans and progress.

3. Works closely with other team members around specific care management tasks and

responsibilities.

4. Communicate clearly and collaborate with patient's Primary Care Provider or Psychiatrist

regarding the patients' condition, progress, and needs.

5. Prepare and lead the multidisciplinary complex care management meetings.

6. Support in maintaining patient health and prevention of secondary disease complications by

providing education, counseling and support about healthy lifestyle changes and specific disease

management topics.

7. Collaborate and participate in the selection, development, and maintenance of patient education

materials.

8. Participate in care transitions for high-risk patients, particularly from acute inpatient and

emergency department settings, back into the medical home.

9. Utilize standing orders and clinical orders for preventative and chronic disease management

within scope of clinical practice.

10. Perform medication review, reconciliation, education, and coordination.

11. Participate in care team huddles and meetings.

12. Participate in the evaluation of the care management programs.

13. Handle protected health information in a manner consistent with the Health Insurance

Portability and Accountability Act (HIPAA).

14. Participate in PrimeCare's quality processes and activities as indicated.

15. Maintain current knowledge of regulatory agency requirements of compliance and ensures that

those standards are practice in the clinic.

16. Other duties and responsibilities as assigned.

Behavioral Health Care Manager:

1. Provide behavioral interventions using evidence-based techniques such as behavioral activation,

problem-solving treatment, motivational interviewing, or other treatments as appropriate.

2. Provide or facilitate in-clinic or outside referrals to evidence-based psychosocial treatments

as clinically indicated.

3. Facilitate referrals for clinically indicated services outside of the organization, ie: social

services such as housing assistance, vocational rehabilitation, mental health specialty care,

substance abuse treatment.

4. Promote clear communication amongst team members regarding patient care plans and progress.

5. Works closely with other team members around specific care management tasks and

responsibilities.

6. Participate in multidisciplinary complex care management meetings.

7. Collaborate and participate in the selection, development, and maintenance of patient education

materials.

8. Communicate clearly and collaborate with patient's Primary Care Provider or Psychiatrist

regarding the patients' condition, progress, and needs.

9. Participate in care transitions for high-risk patients, particularly from acute inpatient and

emergency department settings, back into the medical home.

10. Provide brief behavioral interventions using evidence-based techniques such as behavioral

activation, problem-solving treatment, motivational interviewing, or other treatments as

appropriate.

11. Facilitate referrals for clinically indicated services outside of the organization, ie: social

services such as housing assistance, vocational rehabilitation, mental health specialty care,

substance use disorder treatment.

12. Perform medication review.

13. Participate in care team huddles and meetings.

14. Participate in the evaluation of the care management programs.

15. Handle protected health information in a manner consistent with the Health Insurance

Portability and Accountability Act (HIPAA).

16. Participate in PrimeCare's quality processes and activities as indicated.

17. Maintain current knowledge of regulatory agency requirements of compliance and ensures that

those standards are practice in the clinic.

18. Other duties and responsibilities as assigned.

Physical Demands

1. Must be able to remain in a stationary position 50% of the time.

2. Must be able to move around the clinic site 50% of the time.

3. Consistent operation of computer and telephone.

4. Occasionally positions self to maintain exertion of physical strength to move objects of 10

pounds from one level to another.

5. Must be able to transport from one site to another.

6. Must be able to cover other shifts as necessary.

Required Knowledge, Experience, or Licensure/Registration

1. Active State of Illinois License - Registered Nurse or License Practical

2. Bachelor's Degree in nursing preferred

3. LSW / LCSW (LPC / LCPC) – Active State of Illinois License – LCSW/LSW or LCPC/LPC

4. Master's degree in Social Work or Psychology

5. Two to three years of nursing experience or behavior health related work in an ambulatory

setting or health center

6. Prior experience in Care Management preferred

7. Bi-lingual English/Spanish required.

Comprehensive Health Insurance Benefits through BCBS of IL:

• Health Insurance (HMO/PPO)
• Dental Insurance (HMO/PPO)
• Vision Insurance
• Short/Long-Term Disability Insurance
• Group Life Insurance

Other Benefits Include:

• 403(b) Retirement plan with employer match
• Pension Plan
• Voluntary Life/ AD&D
• Flexible Spending/Dependent Care Accounts
• Annual CME Allowance and CME PTO (Providers Only)
• Paid Time Off
• 1 Floating holiday per calendar year
• 3 Personal days per calendar year
• 7 Holidays per calendar year
• Employee Assistance Program
• Tuition Assistance Program
• Off-the-job Accident Coverage
• Employee Referral Program
• Internal Growth Opportunities

In accordance with Illinois Executive order COVID-19 No.87) effective on August 26, 2021, in conjunction with the Federal CDC guidelines, COVID vaccinations are now a requirement for PrimeCare Community Health as well as many other Healthcare Organizations. Proof of full vaccination is required prior to the beginning date of employment. If you have a medical or religious contraindication, please inform Human Resources when the offer is extended.

PrimeCare Health is firmly committed to creating a diverse workplace and is proud to provide equal employment opportunities to all applicants. Therefore, PrimeCare does not discriminate on the basis of creed, color, national origin, sex, gender identity, sexual orientation, age, religion, marital or parental status, alienage, disability, political affiliation or belief, military or military discharge status.