Chronic Care Manager-Bilingual

PRINE Health is looking for a Bilingual (English/Spanish) Care Manager to join the PRINE Care management team. The schedule is Monday to Friday 9am-5pm. We are looking for an enthusiastic, eager to learn, hardworking, and patient focused individual who pays attention to important details.

• Kidney Disease Education
• Chronic Care Management
• Remote Physiologic Monitoring
• Advanced Primary Care Management (APCM)

This position will require following through with comprehensive care plans with monthly patient contact and educating patients on the basics of Chronic Kidney Disease as well as their treatment options. Our main goal is to coordinate and improve the care we deliver to our diverse patient population and allow them an opportunity to become more educated and work towards a healthier lifestyle.

Key Responsibilities:

• Conduct patient assessment, and create patient care plans and maintain personalized electronic care plans, and set health goals with patients.
• Act as a central point of contact to coordinate care between primary care physicians, specialists, and other external healthcare organizations.
• Provide counseling and education on managing chronic conditions, including medication management and lifestyle adjustments.
• Engage in regular monthly check-ins with patients, answer their health questions, and provide 24/7 access to a care team.
• Help manage transitions between different healthcare settings, such as hospital to home, to reduce readmissions.
• Maintain structured records of patient health information, manage referrals, and document CCM services in the electronic health record (EHR).
• Monitor patient health remotely using telehealth technologies and communicate via digital means.

Skills and qualifications:

• Strong clinical knowledge and experience managing chronic conditions.
• Excellent communication, patient education, and motivational interviewing skills.
• Proficiency with electronic health records (EHR) and other care coordination software.
• Experience coordinating care across inpatient and outpatient settings.
• Ability to work collaboratively with a larger care team and build relationships with administrative staff.
• Knowledge of healthcare policies related to chronic disease management.
• Bilingual (English/Spanish)

Qualifications/Experience:

• Medical Terminology: 1 year (Required)
• Chronic Care Management: 1 year (Required)
• Certificate: Health Coach/CCP (Preferred)

**Candidates with Clinical Care Management with Chronic Disease, Diabetic and Hypertension experience is highly preferred.

About us:

PRINE Health is an independent Nephrology based SUPERGROUP infused with Primary Care, Care Management, and cutting-edge technology.

PRINE is supported by a physician owned managerial service organization (MSO) providing value-oriented Population Health and traditional practice management services.

PRINE seeks to revolutionize kidney care and optimize a new value-based Nephrology solution built for the realities of today and challenges of tomorrow. Our mission has a QUADRUPLE AIM: (1) Improve Quality of Kidney Care (2) Improve Access to Care and Patient Satisfaction (3) Eliminate Waste, Redundancies, and Inefficiencies. (4) Improve the Experience for Physicians and Care Partners.

Job Types: Full-time

Job Type: Full-time

Pay: $25.00 - $27.00 per hour

Benefits:

• 401(k) matching
• Dental insurance
• Health insurance
• Paid time off
• Vision insurance

Experience:

• RN: 1 year (Preferred)
• Care management: 1 year (Preferred)

Language:

• English and Spanish (Bilingual) (Required)

License/Certification:

• Certified Medical Assistant (Preferred)

Willingness to travel:

• 25% (Preferred)

Work Location: In person