Abode Care Partners

The Chronic Care Coordinator will use their health care experience, talents, and problem-solving skills to work independently and manage a monthly allocation of patients to ensure that all assigned patients receive timely, courteous and quality care. The Chronic Care Coordinator will utilize multiple platforms to ensure service is consistent and compliant while developing or revising individualized comprehensive care plans.

Serves as an extension of the clinical team providing telephonic patient care to allocated patients
• Provides monthly assessments and medication reviews, coordinate care plans with family members and caregivers and provide follow-up to office support staff
• Meets monthly Care Plan production goals
• Maintains HIPAA standards at all times
• Achieves monthly goal of telephonic interactions with patients and/or caregivers to achieve positive outcomes
• Follow striage protocols for communicating patient needs
• Documents all client communications in an accurate, efficient, and timely manner
• Delivers excellent customer service as demonstrated by positive feedback from patients and facility staff
• Adheres to documentation protocols and best practices for compliance

• Minimum High School Diploma or GED; Some college or clinical education
• Prior experience in a customer/patient facing capacity required
• Familiarity with Chronic Care Management preferred
• Minimum one year experience in a clinical setting or patient environment
• Experience working with Electronic Health Records (EHR) software
• Clinical credentials to include Certified/Registered Medical Assistant, LPN or other qualified background as approved
• Excellent communication skills
• Comfortable assessing status of patient remotely, active listener
• Ability to recognize condition specific symptoms
• Organized, thorough documentation skills
• Solid time management skills
• Ability to work independently as well as part of clinical care team
• Ability to travel up to 5% upon request