Description

JOB TITLE: CHRONIC DISEASE STATE SPECIALIST

REPORTS TO: DIRECTOR 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.

Qualifications

EDUCATION AND EXPERIENCE

• Licensed Practical Nurse (L.P.N.) with valid state license