Clinical Case Manager

We are seeking an experienced Clinical Case Manager to join our team and make a positive impact on the health of our community! If you're passionate about providing quality care and support to underserved populations, this role offers an excellent opportunity to contribute to improving patients' lives while working collaboratively with a team of healthcare providers and patients' families.

About the Role:

As a Clinical Case Manager, you'll be responsible for guiding patients through the healthcare system, acting as a patient advocate, and helping to close gaps in care. You'll play an essential role in ensuring that patients receive timely and effective care across the healthcare continuum—from appointments and referrals to hospital discharges and follow-ups. You will work closely with patients, healthcare providers, insurers, and clinical staff to ensure the highest quality of care and cost-effective solutions.

Key Responsibilities:

Serve as a patient advocate, assisting individuals as they navigate the healthcare system.
Participate in quality improvement initiatives such as HEDIS, Value-based care, and PCMH to enhance patient outcomes.
Identify and close care gaps by coordinating services and follow-ups for patients.
Oversee continuity of care by collaborating with external healthcare facilities, including hospital admissions, discharges, and specialty referrals.
Lead transitions of care, supporting patients and families following hospital discharges, ER visits, and referrals.
Co-manage high-risk patient care, particularly for those with multiple chronic conditions or at high risk for readmission, in partnership with the Clinical Care Management team.
Address Social Determinants of Health (SDOH) by reviewing screenings and providing community-based resources to patients in need.
Maintain clear and timely communication with the healthcare team through chart documentation and team huddles.
Contribute to data collection, health outcomes reporting, clinical audits, and evaluations related to Patient-Centered Medical Home initiatives.
Support the development of clinical tools, forms, and procedures to enhance patient care and operational efficiency.
Qualifications:

Active LPN certification (CMA experience is also a plus).
1-2 years of prior experience in case management or a related healthcare role.
Experience working with electronic medical records (EMRs); familiarity with Athena is a plus.
Proven ability to collaborate with medical providers (Physicians, Nurse Practitioners) in coordinating care plans.
Experience engaging with insurance companies to obtain patient data and resources.
Ability to manage a caseload of approximately 300 patients per month.
Strong communication skills, both for educating patients and collaborating with their families/support teams.
Proficiency in Microsoft Office (Excel, Word) and intermediate computer skills.
Highly self-motivated, reliable, and detail-oriented.
Strong problem-solving skills with the ability to escalate concerns to providers when necessary.
Excellent interpersonal and customer service skills, contributing to a positive team dynamic.
Ability to work in a fast-paced environment and handle stress and conflict effectively.
Commitment to maintaining confidentiality and complying with all relevant policies and procedures.
What We Offer:

A rewarding role where you can truly make a difference in the lives of patients.
Collaborative and supportive work environment with opportunities for professional growth.
The chance to work on meaningful healthcare initiatives that directly impact the community's well-being.
Employment Type: Full-Time
Salary: $ 110,000.00 Per Year