Chronic Care Management Specialist

Chronic Care Management Specialist

Following all Federal, State, HIPAA, CMS and SC DHEC Chronic Care Management rules and regulations in administering services performed outside of regular office visits for patients with multiple (two or more) chronic conditions expected to last at least 12 months. Follow up on patient’s chronic conditions regarding last visits and outcomes, sick and follow up visits; review of prior authorizations, assistance with forms and medical record requests, medication reconciliation, and obtaining information on recent emergency room visits or hospitalizations. Review patient’s medical documentation to coordinate referrals, such as labs that were performed with other health care teams. Confirm next appointments. Schedule any newly required appointments. Ensure prescriptions ordered have been called into pharmacies. Review current diagnosis and conditions and alert providers of the outcome of the CCM communication; Perform direct CCM services by addressing high risk conditions through (outside of traditional face to face office visits) through telephone calls and other electronic means of communicating to patients, such as ongoing support through the PMC patient portal. Records accurate CCM time; Prepares patient communication and information for their assigned provider, including labs, reports, and all information entering medical records data into eClinicalWorks.

JOB DUTIES AND RESPONSIBILITIES

• Follows all Federal, State, HIPAA, CMS and SC DHEC Chronic Care Management rules and regulations Provides audio CCM services to patients
• Reviews electronic records
• Consult & follow up with patients, patient monitor
• Identifies patients w/ 2 or more chronic conditions
• Medication reconciliation and RX refills (may include pre-auth of meds from ins. Co.)
• Research and Coordinates Lab/DI/procedure orders and results
• Schedules appointments as needed
• Assist and refers services that require prior authorization
• Completion of forms
• Review documentation for Medicare Wellness/Preventative services; ensures plan of care is being followed and updated regularly
• Patient engagement and education of self-care tools
• Coordinate services with health care team and other service providers
• Identify & coordinate Manage Care Transitions (home health referral, SNF)
• Assess medical/functional/psychosocial needs
• Oversee medication management and coordinates medical records
• Review and document deceased patient’s medical record
• Enrolling, disenrolling and updating consent status of CCM in eClinicalWorks in a timely manner

PHYSICAL AND SENSORY REQUIREMENTS

Sitting up to 8 hours per day, 4 hours at a time. Continuously fingering and handling for data entry, typing, etc. and occasional twisting and turning. Uses upper extremities for occasional lifting and carrying up to 10 lbs. Frequently stoops, bends, or reaches above shoulder level to retrieve files. Hearing as it relates to normal conversation and telephone. Seeing as it relates to general vision. Visual monotony when reading reports and reviewing computer screens.