ESSENTIAL DUTIES AND RESPONSIBILITIES include the following.

Other duties may be assigned.

• Manages a caseload of an assigned panel of chronic care patients, including patients with mental health issues.

• Collaborates with physicians, providers, and practice 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.

• Maintains availability to provide telephone advice per protoc...