Chronic Care Management Specialist - BMS Family Health and Wellness Centers : Job Details

As a Chronic Care Management Specialist, you will play a pivotal role in providing comprehensive care management to individuals and families dealing with chronic illnesses. Your primary focus will be on advocating for patients and guiding them through the complex healthcare system. You will work diligently to foster linkages with other healthcare providers and monitor the effectiveness of these connections. Your efforts will contribute to improved adherence to medical appointments, encourage patient independence, and promote overall wellness.

Supervisory Responsibilities:

• Deliver care management, crisis intervention, referrals, and care coordination services for your assigned clients.
• Collaborate with healthcare professionals and the client's support team to create and execute individualized care plans.
• Ensure all documentation and billing are accurate and up-to-date.
• Conduct comprehensive assessments of clients, addressing medical, behavioral, rehabilitation, and long-term care needs.
• Act as a passionate advocate for clients, ensuring they receive the full spectrum of necessary services.

Essential Functions and Duties:

• Engage in client outreach to evaluate ongoing needs, enhance continuity of care, and elevate health outcomes.
• Perform fact-finding as needed and undertake intake processes.
• Work closely with community providers to facilitate service utilization tailored to client needs.
• Design and implement emergency/crisis intervention plans for clients.
• Carry out additional related tasks as needed.

Required Skills/Abilities:

• Strong organizational skills with effective follow-up.
• Exceptional communication skills, both written and verbal.
• Proficient in using computer applications (Microsoft Word, Excel, PDF, PowerPoint, Teams, Zoom).
• Excellent interpersonal abilities.
• Ability to communicate clearly and directly in person and in written correspondence; bilingual in English/Spanish or French is preferred.

Education and Experience:

• A degree in health and/or human services (MSW/MPH/BA/BS) is required, along with two years of relevant experience in behavioral health and/or care coordination.
• CANS (Children Assessment Needs and Strengths) and HARP certifications are a must.

Physical Requirements:

• Ability to sit for extended periods while working on a computer.
• Willingness to conduct field visits in various weather conditions.
• Flexible to travel across different areas as required.

Salary: $55,000