Chronic Disease Manager

Website Peoples Center Clinics and Services Peoples Center Clinics and Services

Peoples Center Clinics and Services

Part Time Chronic Disease Manager  (.4 FTE)

Join our organization whose mission is improving lives, transforming communities, and achieving health equity for everyone.  People’s Center Clinics & Services (PCCS) is a Federally Qualified Health Center located in the heart of Minneapolis, Minnesota. We are physicians, dentists, nurses, social workers, care coordinators, and other healthcare and administrative staff, and serve nearly 10,000 patients every year through medical, dental, and behavioral services. 
We offer competitive compensation and benefits package including:

•    Health, Dental, and vision insurance

•    Retirement plan with company contribution

•    4 weeks of paid time off 

•    8 annual holidays

•    Company paid life insurance benefit

•    Company-paid Short -Term and Long-Term Disability benefits

•    National Health Service Corps loan forgiveness approved site

•    Company paid continuing education dollars and days

•    License and certification expense reimbursement

People’s Center Clinics & Services is a nationally recognized community health center delivering high-quality, affordable, and culturally relevant healthcare since 1970. We offer a full range of integrated primary care, behavioral health, and oral health services.  You can schedule an appointment that suits your schedule or walk-in to our clinics and be seen the same day when needed. All people are welcome here without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status, financial status or ability to pay.  For more information go to


Chronic Disease Manager is responsible for the development, implementation and coordination of quality improvement initiatives related to diabetes and cardiovascular health (D-5, BP, BMI, asa) across all People’s Center Clinics and Services.

In collaboration with the Chief Health Officer, this position provides leadership to the organization’s Quality Improvement program.   Through a health equity lens, the Chronic Disease Manager provides a systematic approach to relevant QI activities.    While cultivating a constructive climate of QI throughout the organization, the Manager focuses on reducing health disparities and improving overall quality of care.  


Management of Quality Improvement Related to Diabetes and Cardiovascular Health
Performance Improvement MeasuresExtracts and compiles data from EMR
Prepares and analyzes clinical dashboards
Collaborates with EPIC trainer to:simplify EMR workflows and ensure complete and accurate data is collected
train staff in EMR workflows
Educates staff about QI tools and processes, including PDSA model
In coordination with medical and clinical leadership, identifies areas for improvement and develops/implements QI initiatives related to organizational strategic goals
Manages projects related to QI initiatives and activities
Diplomatically reviews individual clinical dashboard with staff and offers coaching on needed improvement plans
Performs audits as needed to strategize ongoing improvement
Keeps abreast of industry standards
Staff training: works with MAs and RNs to ensure accuracy of BP monitoring
AHA Grant: in conjunction with Advancement, manage AHA grant
MeetingsAttends monthly MNACHC/FUHN CQI meetings
Attends quarterly Board CQI and C meeting
Attends other meetings as assigned

Population Health: Diabetes/HTN prevention and management
In collaboration with CHO, prepares initiatives for evaluation and management of population health related to diabetes and hypertension prevention and management
Uses population health registry sources to extract and present data for      performance measurement and monitoring of outcomes
Analyzes and evaluates the effectiveness of project activities for results and       outcomes related to strategic goals

RN, RD, CDE, Public Health degree or other health certification required
At least 1-2 years of prior experience in Quality Improvement
Thorough knowledge of Quality/Performance Improvement principles and tools
Experience working with people from diverse backgrounds
Experience addressing health disparities
Proficient in Microsoft Office, including Excel data base management and report generation (Business Objects familiarity preferred)
Excellent written, verbal communication and organizational skills
Strong interpersonal skills, experience inspiring and motivating staff to achieve goals
Interest in community and primary healthcare
Electronic medical record experience preferred (EPIC, OCHIN, WISDOM)

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