Job Description:

Phamily is helping to place an in office Chronic Care Manager/Chronic Care Navigator for our client in Baton Rouge, LA. This individual will be working internally for our client and using the Phamily platform. Phamily is a Chronic Care Management & Proactive Care Platform and More information about the program can be found here Chronic Care Manager is a Licensed Practical Nurse (LPN) who supports the development of patient-centered, team-based care. S/he will support primary care physicians (PCPs) and practices in managing their panel of patients using the Phamily platform.By gathering and organizing patient data, the Chronic Care Navigator works to identify patients' unmet needs, engage patients in their own care, gather summary information for treatment interventions, and enhance ongoing communication between the patient and her/his care team. The goal of the Chronic Care Management program is to facilitate high-value, patient-centered care that improves timely access to and provision of preventive services and chronic disease treatment. Each Care Manager will be expected to manage a 500 patient caseload with 300 billable by the end of month.Disclaimer: While each role is initially screened by the Phamily team, the ultimate hiring and hiring decisions will be made by the client's hiring team.To be considered for an interview, please make sure your application is full in line with the job specs as found below.KEY AREAS OF RESPONSIBILITY:Develop a keen understanding of primary care practice requirements for optimal, coordinated population healthWork as an effective team member of the care teamCollaborate with care teams to establish population-appropriate, pre-visit, and point of care processesWork with the Phamily Chronic Care Management platform to support patients with multiple chronic diseases and assists in coordination of the patients care continuum.Contribute to quality improvement and care redesign of population health effortsManage patient registriesProvide the members of health care teams in designated practices with the data required to meet the health needs of the patientSupport practice staff to develop interventions to proactively manage target populationsContribute to a positive experience for patients and families through courteous telephone and digital interactions, accurate and expeditious routing, as well as referral to appropriate clinical staff when necessaryRecognize and report data inconsistencies to appropriate personnelContribute to the teamwork within and between departments.Regularly attend and participate in meetings with coworkers and practice staff.Perform all job functions in compliance with applicable federal, state, local and company policies and proceduresProvide data to the care teams to properly perform these processesMonitor and correct patient attribution to the practice and the care teams within the practiceOther duties as assignedREQUIRED QUALIFICATIONSLicensed Practical Nurse (LPN) - note: Significant experience inNephrology setting in lieu of licensewill be considered.Proven problem-solver with ability to multitask.Excellent communication skills, both written and spoken.PREFERRED QUALIFICATIONS1+ years of experience inNephrology.Prior use of EHR/EMR systems highly desirable