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Role Specific Responsibilities

  • Drives care coordination efforts for patients with chronic diseases or other diagnoses related health management needs.
  • Maintains caseload while responding to quality and other outcome related measures.
  • Develops and maintains individualized care plans for patients within a given cohort.
  • Maintain health coach or other care management training and/or certification.
  • Conducts concurrent medical record review using specific indicators and criteria selected for care gap reporting.
  • Communicates with Care Team members to coordinate care.
  • Develops and reports on hospitalization and other quality metrics including identification of problem areas and possible plans for improvement
  • Assists with orders for laboratory and diagnostic testing as appropriate per department clinical guidelines.
  • Reports data collected to the SIMS Quality Assurance committee.
  • Works under the supervision of the SIMS Care Transitions Supervisor and SIHMG Regional Practice Director.
  • Participates in department huddles, meetings and other meetings as appropriate.



  • Associates preferred in medical related field

Licenses and Certification

  • Current LPN nursing license
  • RN preferred

Experience and Skills

  • Technical: Minimum of one year experience in the use of Electronic Medical Record systems.


Southern Illinois Healthcare
Herrin, IL
Full Time

Published on 11/24/2021

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