Lead CCM Coordinator (LPN) - Hybrid

Avance Care; Durham (NC); Hybrid; USD 52,000 - 75,000; Full time

Benefits offered by this job

Hybrid work model

Benefits start after 30 days

Job summary

Avance Care is seeking an LPN Care Management Medical Coordinator for our Durham, NC headquarters. The role combines in-office and remote work to support coordinated, patient-centered care across our network.

You will implement and monitor care plans, educate patients, and collaborate with providers to improve health outcomes in a high-growth primary care setting.

Qualifications

• Active LPN license in good standing.
• Minimum of three years in primary care, long-term care, or chronic care setting.
• Experience coordinating care with physicians, nurses and other staff.

Responsibilities

• Coordinate care across the continuum with primary care providers and interdisciplinary teams.
• Educate patients and caregivers on care plans and barriers to achieve goals.
• Track and update care plans monthly to align with treatment goals.
• Assess patient health using EMR data, claims data and other resources.
• Outreach to patients to confirm diagnoses and treatment plans.
• Integrate nutrition, behavioral health and medication therapy management into care plans.
• Identify risks for high utilization and coordinate referrals and services.
• Track hospital/ER visits and ensure follow-up to reduce readmissions.
• Document care activities accurately in the EMR.

Skills

Care coordination

Communication

EMR systems

Patient education

Education

Licensed Practical Nurse (LPN) license

Tools

EMR software

Job description

Overview

Grow Your Career with One of North Carolina's Leading Primary Care Networks!

Join our rapidly expanding network of 35 practice locations across the Triangle Area (Raleigh-Durham-Chapel Hill), the Charlotte Region, and Wilmington, NC.

At Avance Care, we're committed to raising the standard of healthcare. As one of North Carolina's largest independent primary care networks, we provide comprehensive, patient-centered care that supports the physical, mental, and emotional well-being of our patients.

We're currently seeking an LPN Care Management Medical Coordinator to join our growing team! In this role, you'll help implement, monitor, and evaluate individualized care plans, collaborating with patients and providers to deliver high-quality, cost-effective care that improves health outcomes.

• This is a hybrid role based at our headquarters in Durham, combining in-office and remote work for a balanced schedule.
• Supportive Work Environment: We provide a collaborative and encouraging atmosphere where your contributions directly enhance patient health and well-being. You'll also have opportunities for professional growth while making a meaningful impact in the lives of those we serve.
• Comprehensive Benefits: Our robust benefits package becomes available starting on the first of the month following 30 days of employment.

Selected Responsibilities:

• Partner with primary care providers and interdisciplinary teams to coordinate care across the continuum.
• Educate patients and caregivers on care plans, barriers, and achievable health goals.
• Track and update care plans monthly to ensure alignment with treatment goals.
• Assess patient health using electronic medical records, claims data, and other resources.
• Perform outreach to patients to confirm diagnoses, treatment plans, and identify barriers to care.
• Integrate specialty services such as nutrition, behavioral health, and medication therapy management into care plans.
• Identify and address risks for high utilization through coordination of referrals and supportive services.
• Track hospital and ER visits, ensuring follow-up to maintain continuity of care and reduce readmissions.
• Accurately document care activities in the electronic medical record system.

Candidates must hold an active Licensed Practical Nurse (LPN) license and have a minimum of three years of experience in a primary care, long-term care, or chronic care setting.

Other Priorities:

• Strong verbal and written communication
• Ability to maintain confidentiality and integrity
• Growth mindset
• Flexibility and resilience

All offers of employment are contingent upon the successful completion of a background check and drug screen.

Avance Care provides equal employment opportunities (EEO) to all employees and applicants for employment without regard to religion, race, creed, color, sex, sexual orientation, gender identification, alienage or citizenship status, national origin, age, marital status, pregnancy, disability, veteran or military status, predisposing genetic characteristics or any other characteristic protected by applicable federal, state or local law.