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.
