FT Onsite Chronic Care Manager - Missouri at Agency Software in Jefferson City, Missouri

Job Description:

Join our mission to help transform healthcare delivery from reactive, episodic care to proactively managed patient care that prevents life-changing problems before they happen for patients with two or more chronic conditions. We believe every patient with chronic disease deserves consistent check-ins, follow-up, and support.

We are expanding our team to include an On-Site Care Manager to assist our medical practices and patients with in-person enrollments and onboarding to the Chronic Care Management program as well as providing telephonic monthly encounters for care management. This role will be in person at your assigned medical clinic, and you will report to your Esrun Health Supervisor as well as working closely with the on-site staff as a representative of Esrun Health. As a team member at Esrun Health, you will have the ability to make a true impact on the success of our partner clinics while helping to improve the lives of our patients by aiding them in chronic care management.

This is a full-time position and with full-time status, this position will offer full benefits through Harris Computer including Health, Vision, and Dental Insurance, generous PTO, 401K with up to 8% match and many other benefits.

Esrun Health is seeking to staff these positions with Medical Assistants and nurses (both LPN and RN).

What your impact will be:

• The role of the Care Manager is to abide by the plan of care and orders of the practice.


• Ability to provide prevention and intervention for multiple disease conditions through motivational coaching.


• Develops a positive interaction with patients on behalf of our practices.


• Improve revenue by enrolling new patients, creating billable CCM episodes, and increasing visits for management of chronic conditions.


• Develops detailed care plans for both the doctors and patients. The care plans exist for prevention and intervention purposes.


• Understand health care goals associated with chronic disease management provided by the practice.


• Attend regularly scheduled meetings (i.e., Bi-Monthly Staff Meetings, monthly one on one's, etc.) online. These “mandatory” meetings will be important to define the current scope of work.

Your Responsibilities:

• Enrolling and onboarding patients onsite to the Esrun Health platform, providing them with appropriate devices, educating them on how the devices work, and ensuring they can set-up their devices correctly when they return to their homes.


• Completing RTM patient monitoring sessions to review patient medication compliance levels while documenting appropriately in the EHR on the information you are able to derive from the data.


• Completing CCM patient interactions through phone calls to check in on patients monthly and documenting appropriately in the EHR and escalating to practitioners at your clinic if deemed necessary.


• Ensuring all medication and patient data is kept up to date within the EHR and ensuring that all data is kept up to date.


• Monitoring patient medication compliance alerts and assisting patients with medication regimens.


• Meeting with your Esrun Health supervisors to ensure you can complete your day-to-day work as effectively as possible.


• Other duties as assigned

What we are looking for:

• Certified Medical Assistant or graduate from an accredited School of Nursing (LPN, LVN, RN, BSN, etc.)


• Current license to practice as an RN/ LVN/LPN with no disciplinary actions noted.


• A minimum of two (2) years of clinical experience in a Med/Surg, Case Management, and/or home health care.


• Hands-on experience with Electronic Medical Records as well as an understanding of Windows desktop and applications (Microsoft Office 365, Teams, Excel, etc.), also while being in a HIPAA compliant area in office to conduct Chronic Care Management duties.


• Ability to exercise initiative, judgment, organization, time-management, problem-solving, and decision-making skills.

What will make you stand out:

• Quickly recognize condition-related warning signs.


• Organized, thorough documentation skills.


• Self-directed. Ability to prioritize responsibilities. Demonstrated time management skills.


• Clear diction. Applies exemplary phone etiquette to every call.


• Committed to excellence in patient care and customer service.

What we offer:

• Full-time position, to include benefit options (Medical, Dental, Vision, 401K, Life).


• Streamline designed technology for your Chronic Care operations


• Established and secure company since 1976, providing critical software solutions for many verticals in countries ranging from North America, Europe, Asia, and Australia.


• Core Values that unite and guide us


• Opportunities to learn and grow


• Community Involvement and Social Responsibility

About us:

Esrun Health, a division of Harris Computer, is on a mission to redefine remote care. Our program offers a customized model of remote care services that blends Chronic Care Management (CCM), Remote Therapeutic Monitoring (RTM), Remote Physiologic Monitoring (RPM), Behavioral Health Integration (BHI), and/or Transitional Care Management (TCM) for each client based on their specific practice needs.

As a Harris healthcare business, we are able to maintain a people-focused, small company experience with the financial security of a large organization.