Chronic Care Management Coordinator
Overview:
We are seeking a Licensed Practical Nurse (LPN) or experienced Medical Assistant (MA) to oversee our Chronic Care Management (CCM) program. The LPN/MA will coordinate care for patients with chronic conditions, ensuring high-quality support, compliance with CMS guidelines, and improved patient outcomes.
We are seeking a Licensed Practical Nurse (LPN) or experienced Medical Assistant (MA) to oversee our Chronic Care Management (CCM) program. The LPN/MA will coordinate care for patients with chronic conditions, ensuring high-quality support, compliance with CMS guidelines, and improved patient outcomes.
Key Responsibilities:
- Conduct monthly outreach calls to assigned patients.
- Monitor and record patient-reported symptoms, medication adherence, and barriers to care.
- Reinforce patient self-management goals as outlined in the care plan.
- Coordinate referrals, appointments, labs, and testing.
- Collaborate with providers, specialists, and support services.
- Identify and escalate clinical concerns to the provider.
- Review current medications with patient.
- Maintain accurate documentation and ensure billing compliance.
Qualifications and Skills:
- Current LPN license, active and in good standing.
- 2+ years’ clinical experience (chronic disease preferred).
- Strong communication and patient education skills.
- Proficient in EHR systems and documentation. ECW experience a plus but not required.
- Ability to work independently while following clinical protocols
- Patient-centered, organized, detail-oriented, collaborative, and compassionate.
Work Conditions:
- Work is performed in an office work environment.
- Very limited physical effort is required.
- Limited exposure to physical risk.
