CCM LPN: Chronic Care Coordinator

Northwest Florida Community Hospital; Chipley (FL); On-site; USD 48,000 - 62,000; Full time

Benefits offered by this job

Medical, dental, vision insurance

PTO

401(k) retirement plan

Life insurance

Disability benefits

EAP & wellness benefits

Continuing education

Certification incentive pay

Day shift

Growth opportunities

Job summary

Northwest Florida Community Hospital in Chipley, FL is seeking a full-time LPN to join our Medical Clinics in a Chronic Care Management role.

You will work with providers to coordinate care for patients with chronic conditions, focusing on outreach, education, follow-up, and care coordination, using the EMR.

The position offers a stable day shift and comprehensive benefits with opportunities for professional development within NFCH.

Qualifications

• Current Florida LPN license in good standing.
• Graduate of an approved practical nursing program.
• Current BLS certification.
• Experience in medical clinic, primary care, chronic care management, or care coordination preferred.
• Strong communication, organization, and documentation skills.
• Comfortable communicating with patients by telephone and using electronic medical records.
• Ability to work independently while collaborating with providers and clinic staff.
• Knowledge of chronic conditions (diabetes, hypertension, COPD, heart disease) preferred.

Responsibilities

• Conduct routine outreach and follow-up with patients enrolled in Chronic Care Management.
• Assist with developing and maintaining individualized patient care plans.
• Educate patients on chronic conditions, medications, treatment plans, and provider recommendations.
• Review medications with patients and communicate concerns or discrepancies to the provider.
• Monitor patient-reported symptoms and communicate changes to the provider.
• Coordinate referrals, appointments, testing, and follow-up care.
• Assist with transitions of care after hospitalizations and ER visits.
• Communicate with providers, pharmacies, specialists, and other team members.
• Review patient records for outstanding testing, referrals, appointments, and preventive care needs.
• Document patient communication, care coordination activities, and CCM services in the EMR.
• Maintain tracking of CCM activities and time for billing and compliance.
• Maintain patient confidentiality and HIPAA compliance.
• Perform additional nursing and clinic duties within LPN scope as assigned.

Skills

LPN license

BLS certification

Communication skills

Documentation

Independent worker

Care coordination

Chronic conditions knowledge

Phone communication

Education

Graduate of an approved practical nursing program

Tools

Electronic Medical Records (EMR)

Job description

Northwest Florida Community Hospital in Chipley, FL is seeking a full-time LPN to join our Medical Clinics in a Chronic Care Management role.

You will work with providers to coordinate care for patients with chronic conditions, focusing on outreach, education, follow-up, and care coordination, using the EMR.

The position offers a stable day shift and comprehensive benefits with opportunities for professional development within NFCH.