JOB TITLE: CHRONIC DISEASE STATE SPECIALIST
REPORTS TO: DIRECTOR OF INFORMATION TECHNOLOGY
STATEMENT OF PURPOSE:
The Chronic Disease State Specialist promotes the health and wellness patients of Sun Life Family Health Center who have at least one diagnosis of a CHRONIC DISEASE. This individual will be responsible for identifying and closing gaps in care for patients with a chronic condition, as defined by Sun Life Family Health Center.
ESSENTIAL FUNCTIONS:
- Conducts data reporting to identify gaps in care or services and conducts patient outreach to facilitate follow-up care or services
- Provides patient education
- Provides post-care follow-up
- Obtains prior-authorization and/or referrals to other healthcare services or providers as necessary
- Verifies coverage and benefits with insurers
- Provides patient education sessions for various health conditions; e.g., diabetes, CHF, COPD, etc.
- Participate in in-service/education regarding Quality Improvement.
- Performs Chronic Care Management services for Medicare beneficiaries
- Perform all other related duties as assigned or requested.
EDUCATION AND EXPERIENCE
- Licensed Practical Nurse (L.P.N.) with valid state license