Clinical Care Specialist

The Clinical Care Specialist will maintain and monitor their own patient census across multiple facilities, coordinating the implementation of Chronic Care Management (CCM) services amongst chronically ill patients residing in long term care facilities. Responsibilities include creating individualized Care Plans, updating and tracking monthly progress, and monitoring labs, vitals, medications, and testing. The role involves care coordination with patients, their care team, and their families through email, text, and phone communication, along with patient education on managing chronic conditions. Constant communication and coordination with physicians, physician assistants, nurse practitioners, pharmacists, and other health care professionals is required. The specialist will also assess and identify clinical and non-clinical gaps in patient care and provide training and support to the Provider and CCS team.