Chronic Care Management Coordinator

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.
• Collaborate with providers, specialists, and support services.
• Coordinate referrals, appointments, labs, and testing.
• 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.
• Able 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.