Senior Care Coordinator for High-Risk Patients

Alivio Medical Center, Inc.; Chicago, Northern (IL, KY); Hybrid; USD 55,000 - 65,000; Full time

Job summary

Alivio Medical Center, Inc. in Chicago, IL is seeking a Patient Care Manager to coordinate care for patients with complex chronic needs. This role includes screening, risk assessments, care planning, and direct patient interaction, including telephonic support.

The Care Manager will lead care coordination efforts, promote self-management, and ensure effective communication with primary care providers, with emphasis on transitions of care and HIPAA compliance.

Qualifications

• Education: Bachelor’s Degree in either social work, nursing or related title.
• Licensure: Licensed Social Worker or Nurse, Professional Counselor or related field.
• Experience: 3-5 years of experience with 1-2 years in disease management or care management.

Responsibilities

• Identifies, tracks and manages care for high risk patients.
• Conducts initial care coordination screening eligibility and performs Comprehensive Risk Assessments and Care Plans.
• Provides ongoing clinical assessments, monitoring and follow up for high risk patients.
• Develops relationships with patients and primary care providers to complete care management tasks.
• Promotes behavioral activation interventions, including motivational interviewing and self-management support.
• Coordinates transitions of care with in-network MHN hospitals and post-discharge follow ups.
• Uses standing orders for chronic disease management within scope of practice.
• Assesses psychological needs and refers to community resources when appropriate.
• Manages scheduling of follow ups across primary/specialty care and other organizations.

Skills

EMR

MHNConnect

MS Word

MS Excel

Time management

Org skills

Problem solving

Decision making

Customer service

Communication

Bilingual EN/ES

Education

Bachelor's degree in social work, nursing or related field

Job description

Alivio Medical Center, Inc. in Chicago, IL is seeking a Patient Care Manager to coordinate care for patients with complex chronic needs. This role includes screening, risk assessments, care planning, and direct patient interaction, including telephonic support.

The Care Manager will lead care coordination efforts, promote self-management, and ensure effective communication with primary care providers, with emphasis on transitions of care and HIPAA compliance.