Chronic Care Navigator - Phamily

Chronic Care Navigator
 

Job Title:        Chronic Care Navigator (full time)

Locations:       3630 Sunset Blvd West Columbia SC 29169

Hours:              Monday – Thursday 8:00AM – 5:00PM; Friday 8:00AM – 1:00PM (Full-time)

Minimum Qualifications: 

• Minimum of 1 years’ experience in nephrology. 
• Proven problem-solver with ability to multitask.
• Excellent communication skills, both written and spoken. 
• Certified Medical Assistant from a nationally recognized organization.
   

Job Description: 

The Chronic Care Navigator is a medical assistant who supports the development of patient-centered, team-based care. S/he will support our nephrologist in managing their panel of patients using the Phamily platform. Phamily is a Chronic Care Management & Proactive Care Platform and More information about the program can be found here https://phamily.com/ccm-solution/.

By gathering and organizing patient data, the Chronic Care Navigator works to identify patients’ unmet needs, engage patients in their own care, gather summary 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.

Key Responsibilities:
 

• Have a keen understanding of nephrology requirements for optimal, coordinated population health.
• Work as an effective team member of the care team.
• Collaborate with care teams to establish population-appropriate, pre-visit, and point of care processes.
• Work with the Phamily Chronic Care Management platform to support patients with multiple chronic diseases and assists in coordination of the patients care continuum.
• Contribute to quality improvement and care redesign of population health efforts.
• Support practice staff to develop interventions to proactively manage target populations.
• Contribute to a positive experience for patients and families through courteous telephone and digital interactions, accurate and expeditious routing, as well as referral to appropriate clinical staff when necessary.
• Recognize and report data inconsistencies to appropriate personnel.
• Contribute to the teamwork within and between departments. 
• Regularly attend and participate in meetings with coworkers and practice staff.
• Perform all job functions in compliance with applicable federal, state, local and company policies and procedures.
• Provide data to the care teams to properly perform these processes.
• Monitor and correct patient attribution to the practice and the care teams within the practice.
• Other duties as assigned. Refer to the Certified Medical Assistant job description for detailed responsibilities. While you may handle some of these duties, they will not overlap with those of the Chronic Care Navigator role. 

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