Job Description

Phamily is helping to place a hybrid-remote Chronic Care Manager/Certified Medical Assistant for our client in Leander, Texas. This individual will work internally for our client, Austin Pulmonary, using the Phamily platform. Phamily is a Chronic Care Management & Proactive Care Platform. More information about the program can be found here

The Chronic Care Manager is a CMA \who supports the development of patient-centered, team-based care. S/he will support primary care physicians (PCPs) and practices in managing their panel of patients using the Phamily platform.

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 Chronic Care Management program aims to facilitate high-value, patient-centered care that improves timely access to and provision of preventive services and chronic disease treatment. Each Care Manager will be expected to manage a 500-patient caseload with 300 billable by the end of the month. 

Disclaimer: While the Phamily team initially screens each role, the client's hiring team will make the ultimate hiring and hiring decisions.

Areas of Responsibility

• Develop a keen understanding of primary care practice 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 assist in coordinating their care continuum.
• Contribute to quality improvement and care redesign of population health efforts
• Manage patient registries 
• 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
• 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

Requirements

• Minimum of 2 years experience in relevant specialty. Experience in population health preferred.
• 3 months in the office for training after training position becomes remote
• Proven problem-solver with ability to multitask.
• Excellent communication skills, both written and spoken. 
• Certified Medical Assistant from a nationally recognized organization. Note: Significant experience within a primary care setting with quality/population health experience in lieu of certification will be considered.

Preferred Qualifications

• Prior use of EHR/EMR systems highly desirable
• Bi-lingual English-Spanish preferred but not required
• Preference given to candidates who can travel to the client’s office for in-person training but proximity is not required. 
• Salary: $18 / hour
• Hours: Mon-Th: 07:30-5, Friday: 07:30-12

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