Benefits:

401(k)

401(k) matching

Competitive salary

Dental insurance

Health insurance

Paid time off

Vision insurance

Position Overview: The Chronic Care Management Care Coordinator is responsible for ensuring that patients with chronic conditions receive comprehensive, coordinated care to improve health outcomes and quality of life. The Care Coordinator works closely with healthcare providers, patients, and their families to develop personalized care plans, monitor progress, and address any concerns related to ongoing care.

Key Responsibilities:

Care Coordination:

Collaborate with physicians, nurses, and other healthcare professionals to create and implement personalized care plans for patients with chronic conditions (e.g., diabetes, hypertension, heart disease, etc.).

Monitor patients’ health status through regular check-ins, telehealth calls, and in-person visits.

Schedule follow-up appointments and ensure that all aspects of care are being properly coordinated.

Patient Education & Support:

Provide education to patients and their families on managing chronic conditions, including lifestyle changes, medication management, and symptom tracking.

Encourage patients to adhere to their treatment plans and attend regular health screenings and appointments.

Health Monitoring & Assessments:

Track patient progress toward care plan goals, noting any changes in symptoms or health status.

Perform health assessments to identify potential complications or areas of concern.

Data Management:

Document patient information, care plans, and progress notes accurately and in compliance with healthcare regulations (e.g., HIPAA).

Use electronic health records (EHR) to update and track patient information, ensuring that all data is up-to-date.

Patient Advocacy:

Act as the primary point of contact for patients, advocating for their needs and concerns while ensuring they receive the appropriate resources and support.

Assist patients in navigating the healthcare system, including securing necessary referrals and accessing community resources.

Collaboration & Communication:

Communicate effectively with patients, families, physicians, and other healthcare providers to ensure a cohesive care plan and seamless delivery of services.

Participate in team meetings and case discussions to provide updates on patient progress and challenges.

Quality Improvement:

Contribute to ongoing initiatives aimed at improving patient outcomes and streamlining care processes.

Collect and report data on patient outcomes and care quality metrics to ensure continuous improvement.

Qualifications:

Education:

A Bachelor’s degree in Nursing (BSN), Social Work, Health Administration, or a related field is typically required.

Certifications such as CCM (Certified Case Manager) or CMC (Certified Medical Care Coordinator) may be preferred.

Experience:

Experience in healthcare, particularly in chronic disease management, case management, or care coordination.

Familiarity with electronic health records (EHR) and telehealth platforms is beneficial.

Skills:

Strong communication skills for interacting with patients and healthcare providers.

Excellent organizational and time management skills to handle multiple cases simultaneously.

Compassionate, patient-centered approach to care.

Knowledge of chronic diseases and treatments, including medications, therapies, and lifestyle modifications.