T.H.E. CLINIC, INC.
JOB DESCRIPTION
POSITION: Chronic Care Case Manager
DEPARTMENT: Medical
STATUS: Full-Time, Non-Exempt
POSITION SUMMARY:
Under the clinical direction of the Chief Medical Officer, the Chronic Care Case Manager
provides care management and coordination services to patients with two or more
chronic conditions, e.g., diabetes, hypertension, chronic obstructive pulmonary disease
(COPD), and asthma. The Chronic Care Manager will be a strong force in T.H.E.'s
preventive care efforts to help patients to achieve their optimum level of wellness.
Essential Duties and Responsibilities:
• Administer comprehensive assessments for patients with chronic conditions.
• Establish, implement, monitor, and revise comprehensive care plans that are
tailored to each patient and addresses all health issues, including medical and
psychosocial issues, with special focus on each patient's chronic conditions.
• Educate patients on lifestyle adjustments and give them the tools they need to
monitor and manage their chronic conditions and any medications.
• Follow-up with each patient for the duration of their care plan to ensure patients
stay on track.
• Record patient health and health monitoring information in the electronic medical
record.
• All other duties as assigned.
Qualifications and/or Experience Requirements:
• California Nursing License and CPR Certification;
• Completion of an approved Nurse Practitioner's Program issued by an accredited
college or university and possession of a State of California-issued medication
furnishing number;
• Min. 5 years of combined community clinic experience and care/case management
experience;
• Ability to communicate effectively with patients and other providers, and to work
effectively as a team unit;
• Ability to work with people of diverse cultural, educational, social, and economic
backgrounds;
• Ability to work independently, under pressure, and a self-starter with minimal
supervision;
• Excellent oral and written communication skills;
• Excellent organizational skills;
• Experience utilizing an Electronic Medical Records (EMR) system, preferred; and
• Bilingual in Spanish preferred.