Clinical Care Manager

Signature Medical Group is transitioning to the Patient Centered Medical Home (PCMH) model of care. The model promotes primary care that is accessible, continuous, comprehensive, family centered, coordinated, compassionate, and culturally effective. The Clinical Care Manager position is an integral member of the PCMH team and focuses on the following goals for identified high risk patient populations: · Managing care via integrated care plans, health goals and continuous assessments · Providing self care resources along with activation interventions and teaching · Coordinating care by optimizing the EMR, leveraging community resources and improving intra and inter team communications · Working as part of a multidisciplinary care team to provide patient-centered care and to lower total medical expense of high risk/high cost patients The Clinical Care Manager manages a caseload of approximately 75 high risk/ complex patients; of which 20-30 patients are actively followed. This individual...