Chronic Condition Manager RN Anderson, SC

Marathon Health is a leading advanced primary care provider partnering with employer and union plan sponsors to improve health for millions of Americans. With nationwide onsite nearsite and network health centers and virtual primary care Marathon delivers a value-based model that enhances the healthcare experience for members and providers while driving meaningful cost savings for plan sponsors. Marathon is proud to be certified as a Great Place to Work reflecting the companys commitment to building an inclusive high-trust culture where all employees can thrive. Learn more at

ABOUT THE JOB

Facilitate develop monitor measure and report on wellness and chronic disease prevention and management programs that complement the Health Center maintained and coordinated by Marathon Health. The Chronic Condition Manager will educate counsel and coach patients on how to prevent and/or manage chronic disease in face-to-face virtual and/or telephonic formats as well as in one-on-one and/or group settings. The CCM may also be responsible for developing educational materials. The CCM may be asked to coordinate efforts among all client vendors to provide cohesiveness of services and to better engage the client population. These duties are carried out for a specific client at its various locations.

ESSENTIAL DUTIES & RESPONSIBILITIES

• Facilitates chronic condition management and prevention programs including but not limited to: Diabetes Management Diabetes Prevention Hypertension Management Hyperlipidemia Management COPD Asthma Obesity and Cardiovascular Disease. Programs include clinical educational and health coaching components
• Develops individualized interventions designed to improve and maximize health outcomes
• Conducts thorough and objective evaluations of the patients status including psychosocial physical financial and educational needs prognosis and past and present treatment course and services
• Identifies and enrolls individuals that qualify for chronic condition management programs
• Establishes supportive and confidential relationships with patients
• Assesses patients clinical and educational knowledge of chronic condition readiness to change behavior and individualizes program/s based on needs
• Collaborates with other members of the healthcare team such Nurse Practitioners Physician
  Assistants Medical Doctors Health and Wellness Coaches to optimize care and solve
  problems
• Conducts outreach via phone email and regular mail
• Provides face-to-face virtual and telephonic lifestyle and behavior-related health coaching in both individual and group settings
• Reviews HRA results if applicable and provides education and counseling to patients based on risk factors
• Follows workflow and policy guidelines for documentation in the electronic medical record including the utilization of predictive modeling and behavior change analytics tools
• Applies critical thinking skills and problem-solving techniques to the condition management process
• Participates in the analysis of available data review of reports and strategy for enrollment of members to condition management programs
• Performs in-person virtual telephonic and/or electronic proactive outreach to members that are eligible for disease management programs as well as to unengaged members
• Utilize Evidence Based Medicine in clinical decision making particularly with medication management diagnostic and lab testing orders and providing support/education to patients in making healthy lifestyle & behavioral changes.
• Completes accurate timely and thorough documentation in EMR system.
• Support the mission vision and values of Marathon Health.
• Participate in and complete all mandatory Marathon Health trainings and meetings and comply with organizational policies and procedures.
• Participates in education sessions coordinated by Marathon clients for their respective eligible patient population
• Coordinates efforts with other vendors (carriers EAP etc.) to inform client population of all available resources
• Communicates with Marathon Corporate and/or carrier to provide compliance-related information and necessary documentation
• Directs patients to onsite providers primary care physicians and/or specialists as needed
• Maintains current knowledge of disease processes available resources and treatment options appropriate to patient populations.
• Performs other duties as assigned

QUALIFICATIONS

• Registered Nurse (RN) or Bachelors degree in Nursing (BSN) plus a minimum 3 years experience in chronic disease management. (Diabetes Care Cardiac and Pulmonary
• Rehabilitation etc.)
• Certified Diabetes Care and Education Specialist (CDCES) strongly preferred

DESIRED ATTRIBUTES

• Passionate about transforming the way healthcare is delivered.
• Passionate about the patient experience.
• Desire to improve the quality of care for people.
• Enjoy working in a collaborative team environment where patients come first
• Entrepreneurial spirit and a passion for creating and driving best practices.
• Willingness to go the extra mile for patients.
• Great customer service skills.
• Ability to work autonomously.
• Demonstrated competence in multi-tasking
• Excellent critical thinking skills
• Experience leading and developing presentations. High energy personal style and aptitude for process-oriented thinking
• Track record of consistent stable employment along with the ability to work independently and as a part of a team

Pay Range: $75000 - $90000/yr

The actual offer may vary dependent upon geographic location and the candidates years of experience and/or skill level.

We are accepting applications for this position until a candidate has been selected. To apply to this position and learn more about open jobs at Marathon Health visit our careers page.

Marathon Benefits Summary

We believe in empowering teammates to do their best work and build better healthcare. Below are some of our benefit offerings. Eligibility is based on 24/hr week.

• Health and Well-Being: Free Marathon membership for in person and virtual care employer paid life and disability insurance and choice in medical/dental plans vision employer funded HSA FSA and voluntary illness accident and hospitalization plans. Benefits are effective on the first of the month following date of hire.
• Financial Support: Competitive compensation 401k match access to financial coaching through our Employee Assistance Program
• Lifestyle: Paid time off for vacation sick leave and more holiday schedule