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Chronic Care Management Coordinator

Digestive Disease Consultants

  • Altamonte Springs, Florida
  • 30+ days ago

    Highlights

    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.

    Numbers & Facts

    LocationAltamonte Springs, Florida

    Description

    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.

    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.

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