1+ months

228000 Clinical Care Manager

Penn Medicine
West Chester, PA 19380
Clinical Care Associates (CCA) is Penn Medicines community-based network of primary care and specialty providers. With over 25 Primary Care practices located in and around the Philadelphia area, CCAs top priority is to provide exceptional, high quality care to all of our patients. To that end, we are building a team of Ambulatory Nurse Care Managers who will work directly with our Primary Care practices to optimize the delivery of longitudinal care management and episodic care management. Patient interactions will be conducted by telephone and in-person, as appropriate to patient needs. Job responsibilities include:¢\tSupport the development and implementation of care management activities for high risk patients such as those who are not meeting desired clinical outcomes, who have frequent hospitalizations or ER visits, and those with uncontrolled multiple chronic conditions in the ambulatory setting.¢\tDevelop comprehensive care plans and document progress and interventions in the Electronic Health Record (EHR).¢\tDevelop and implement a patient risk stratification model that aims to identify patients with chronic disease who are at risk and may require focused care management support to achieve the patients optimal health goals.¢\tCollaborate with Data Analyst to create, use, and maintain a care management reporting structure that identifies patients who are likely to benefit from care management services and is able to track the progress of eligible patients who are receiving care management services.¢\tTargeted clinical assessments, medication reconciliation, psychosocial and self-management assessment and support, multi-disciplinary care planning, identification of relevant social determinants of health, and ongoing treatment plan adjustment and evaluation.

Candidates must possess a BSN and a RN license in the state of Pennsylvania. At least 2 years of nursing experience is required.

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Posted: 2019-09-05 Expires: 2019-11-03

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228000 Clinical Care Manager

Penn Medicine
West Chester, PA 19380

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