Sun River Health provides the highest quality of comprehensive primary, preventative and behavioral health services to all who seek it, regardless of insurance status and ability to pay, especially for the underserved and vulnerable. Sun River Health is a Federally Qualified, Non-Profit Health Center serving communities in Suffolk, Rockland, Orange, Dutchess, Ulster, Sullivan, Columbia and Westchester County. Sun River Health is currently seeking a full-time Chronic Care Manager to support our Poughkeepsie site.

Will provide telephonic care coordination services to Medicare eligible patients. These services will include coordination of medication refills, referral and diagnostic imaging results. This position will be responsible for documenting all services in eCW as well as communication with internal clinical or behavioral health team. This position will assist in linking patients to services for daily activities, food insecurity and home care assistance.

• Ability to complete referral process and documentation in eCW.
• Provides supportive services to the patients for issues related to social determinants of health, including but not limited to food resources, heat assistance and day care programs.
• Ability to provide instruction to patients on use of the portal.
• Determines and confirms eligibility of patients who are able to receive the CCM services.
• Provides basic health information and education to patients through the portal and telephonic sessions.
• Completes 200-20 minute claims monthly, appropriately document the time logs and CCM documentation.
• Participates in all trainings and meetings associated with the CCM program.
• Knowledge of eCW basics for insurance, appointment setting, referral management and some clinical documentation

Education: High School Graduate/GED -Required