Seeking a dedicated Chronic Care Manager - Registered Nurse with experience in Kidney Disease to join on a full-time basis. In this role, you will be responsible for coordinating the care of patients with chronic neurological conditions, ensuring comprehensive management, support, and education to optimize patient outcomes. The ideal candidate will have a strong background in neurology, excellent communication skills and technical ability, and a passion for improving the quality of life for patients living with chronic neurological diseases.

The Chronic Care Manager is a Registered Nurse specializing in Kidney Disease. S/he will manage a panel of chronic care patients using the Phamily platform, a communication technology that enables high quality Chronic Care Management at scale. More information on the Phamily platform and CCM program can be found here: https://phamily.com/solution/phamily-ccm-platform/

The Chronic Care Manager works to identify patients’ unmet needs, engage patients in their own care, gather 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. The Chronic Care Manager will be expected to manage a 500 patient caseload using the Phamily platform which will enable you to handle this caseload in the most efficient and effective manner .

Disclaimer: While each candidate is initially screened by a Phamily Recruiter, hiring decisions will ultimately be made by the employers hiring team.

Requirements

KEY AREAS OF RESPONSIBILITY:

• Collaborate with Neurologists and clinical staff to develop individualized health care plans for patients with chronic neurological conditions such as epilepsy, Parkinson’s disease, multiple sclerosis, and others.

• Provide education and support to patients and their families on disease management, treatment options, and lifestyle modifications to enhance patient self-management skills.
• Work with the Phamily Chronic Care Management platform to support multiple chronic disease patients; coordinating care transitions and ensuring continuity of care.
• Conduct comprehensive assessments of patients' neurological health, including symptom management, medication adherence, and functional status.
• Provide the members of health care teams in designated practices with the data required to meet the health needs of the patient.
• Support practice staff to develop interventions to proactively manage target populations.
• Regularly attend and participate in meetings with coworkers and practice staff as well as Phamily support team.
• Perform all job functions in compliance with applicable federal, state, local and company policies and procedures.

REQUIRED QUALIFICATIONS

• Must be a Registered Nurse with 5 years of experience; preferably in a clinical setting.
• Strong knowledge of neurological conditions, treatments, and evidence-based practices in chronic disease management.
• Demonstrated ability to work independently, prioritize tasks, and manage time efficiently in a fast-paced environment.
• Excellent interpersonal skills with the ability to communicate effectively with patients, families, and healthcare team members.
• Familiarity with EMR/EHR systems

PREFERRED QUALIFICATIONS

• Prior Care Management experience - working with patients with chronic conditions

Benefits

• 401(k)
• 401(k) matching
• Bereavement leave
• Dental insurance
• Disability insurance
• Flexible spending account
• Free flu shots
• Free parking
• Health insurance
• Health savings account
• Life insurance
• Paid jury duty
• Paid time off
• Vision insurance