Registered Dietitian - Chronic Care Manager

Crossing Healthcare•Decatur, IL

11d•$60,000 - $79,000

About The Position

Under the supervision of the Chief Medical Officer, the Chronic Care Manager is responsible for managing a caseload taken from a population of individuals that meet requirements for various Crossing Healthcare quality programs. The Chronic Care Manager works closely with patients and their families, clinical support staff, nursing leadership, and physicians/APPs to achieve goals of improving clinical outcomes for patients with chronic diseases and assists with the development of processes that support Crossing Healthcare’s initiatives.

Requirements

Effective communication skills.
Effective logic, reasoning, and critical thinking.
Strong organizational and interpersonal skills.
Ability to work independently, exercise creativity, be attentive to detail, and maintain a positive attitude.
Ability to manage multiple and simultaneous responsibilities.
Maintain patient confidentiality at all times.
Relate to Patient Population showing strong empathy to the medically underserved and desire to reasonably meet them where they are.
Comply with all organizational policies and standards regarding ethical business practices.
Complete annual education requirements as determined by Chief Medical Officer.
Perform other duties as assigned.
Bachelor’s degree in nursing, nutrition and dietetics, healthcare administration, health informatics or other related field.
Employee may occasionally lift, carry, and/or move up to 25 pounds.
Ability to work in conditions that include exposure to blood, bodily fluids and tissues, contagious diseases and/or other potentially hazardous materials

Nice To Haves

Experience with chronic care management preferred.

Responsibilities

Manages a caseload of an assigned panel of patients with chronic health conditions.
Collaborates with physicians, advanced practice providers, and clinical staff in identifying appropriate patients for care management.
Develops relationships with patients as an integral member of the team.
Provides follow-up management with patients to ensure compliance with their individual care plan.
Anticipates the needs of the patient population, seeing that necessary documentation and pre-visit planning is completed or requested before patient visit.
Promotes patient self-management and empowers patients/families to achieve maximum levels of wellness and independence.
Determines and coordinates appropriate referrals as needed.
Works with patients and patient’s care team to coordinate change readiness, needs assessment and to develop an individualized treatment care plan.
Collaborates with the patient, physician/APPs, and other care team members in assessing the patient’s progress toward individual health care goals.
Collaborates with other Chronic Care Managers for additional services when appropriate.
Maintains accessible, consistent documentation of patient self-management measures, and reporting progress toward goals.
Assists patients in setting achievable goals for self-management, teaches them how to do self-management tasks, and reports abnormal findings to their care team.
Assesses barriers when the patient has not met treatments goals, is not following the treatment plan of care, or has not kept important appointments.
Oversees the development, procurement, and adoption of patient self-management educational resources used by the primary clinical teams.
Utilizes the Institute for Healthcare Improvement (IHIs) Chronic Care Model as the foundation and framework for chronic illness care management.
Develops a list of medical supply and community resources available to patients and maintains collegial relationships with the entities used most frequently.
Must keep up to date with the latest chronic disease research, as recommended by the Chief Medical Officer.
Be able to explain complicated topics in a way that people with less medical knowledge can understand.
They must be able to clearly explain eating plans to clients and to other healthcare professionals involved in a patient’s care.
Document patient interactions and progress in EMR.
Other duties as assigned.