Case Manager-Endo Clinic

Website La Maestra Family Health Center

Job Title: Case Manager-Endo Clinic

Reports To: Specialty Clinics Director

Status/Hours: Non Exempt


The Case Manager is responsible for providing comprehensive case management for Endocrinology Clinic and support for the Liver Clinic /NASH patients.  Receives referral reports from physicians and medical assistants, calls and responds to patients’ needs in person or by telephone.


  • Responsible for assessment, case plan development and advocacy.
  • Responsible for the overall flow of patient care, and scheduling examinations.
  • Provides follow up patient care, health education for patients with Diabetes, Fatty Liver/ NASH patients.
  • Interviews patients to ascertain nature of referral visit. Records information on standard forms and logs.
  • Coordinates with the Medical Support Assistant the scheduling of Endocrinology Clinic.
  • Coordinates timely flow of patient care in the clinic as well as coordinating pre-clinic reviews for Endocrine clinics and specialty clinics.
  • Lead person on all Libre Continue Glucose Monitoring (CGM) clinics, education, and programming with assistance from the Model Dietitian.
  • Provides follow up with Health Care Providers (HCP) consults in EHR for Diabetes education, CGM, Podiatry, and Nephrology clinics.
  • Communicates with physicians or medical offices to which the patient us being referred for medical care. Routes form to appropriate physician or office for action.
  • Works closely with our Health Education Department to carry out DM clinics and model diabetes program activities
  • Assists with the annual diabetes audit and HEDIS measures for different Health Plans.
  • Performing miscellaneous reception and office duties in connection with charting, referrals, appointments, and assuring that appropriate supplies (educational materials, CGM tools, etc.) are adequate for Endocrine clinics.
  • Collaborates with other health care professionals regarding clinical issues and patient care.
  • Communicate issues and concerns following the chain of clinical command.
  • Maintains up to date reference materials and files.
  • Communicates with patients to make appointments
  • Meet minimum requirement of 20 referrals per day
  • Maintain effective communication and working relationships with other employees and patients

Additional Duties and Responsibilities

  1. Attend staff meetings
  2. Performs other duties as assigned by Director of Specialty Clinics

Patient Centered Medical Home Essential Responsibilities (Principals)

  • Collaborate with individual patients, their personal physicians, and when appropriate the patient’s family to ensure accessible, comprehensive, compassionate, and culturally competent care
  • Facilitate care by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner.
  • Ensure all decisions respect patients’ wants, needs, and preferences and that patients have the education and support they require to make decisions and participate in their own care.
  • Continually strive to attend to each patient “whole person,” in the context of the patient’s personal and medical history and life circumstances, rather than focusing on a particular disease, organ, or system

Job Requirements

Education:  Bachelors Degree or Equivalent

Experience: 1-2 years experience in physician office or knowledge of FQHC, patient services representative, or similar experience.


Verbal and Written Skills to perform the job:  Bilingual (English/Spanish). Familiarity with basic word processing, spreadsheet, and database applications.  Accurate keyboarding skills.

Technical knowledge and skills required to perform the job:  Excellent verbal, written and interpersonal communication skills and the demonstrated ability to work with diverse individuals and groups.  Demonstrate high levels of self-initiation and direction. Knowledge of communities we serve. Knowledge and experience working in medical settings and interacting collaboratively with medical teams.  Skill in analyzing situations and making timely decisions.

Physical and Mental Requirements:  Work involves sitting, talking, hearing, using hands to handle, feel or operate objects, tools, or controls, and reaching with hands and arms. The employee may be required to push, pull, lift, and/or carry up to 20 pounds. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Interested Applicants please submit Cover Letter and resume to:
Human Resources Department
Email: | Fax: 619-269-1291

La Maestra Community Health Centers is an equal opportunity employer and does not
discriminate on the basis of race, religion, color, sex, national origin, age, sexual orientation, gender, disability or any other legally protected status.

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