Registered Nurse – Chronic Care Management (CCM) Lead

Georgia Interventional Pain; Lawrenceville (GA); Hybrid; USD 90,000 - 115,000; Full time

Job summary

Summit Spine and Joint Centers is seeking an experienced full-time Registered Nurse to serve as the clinical lead for our Chronic Care Management program. The RN Lead will guide the CCM team, oversee patient outreach, and ensure documentation and care coordination meet program standards.

The ideal candidate will have 5+ years of nursing experience, a current RN license, and proven ability to supervise high-volume telephone outreach, coordinate care, and collaborate with providers to improve

Qualifications

• Active, unrestricted RN license.
• 5+ years of nursing experience.
• Experience coordinating care for chronic/complex conditions.
• Strong clinical assessment and escalation skills.
• Excellent verbal and written communication.
• Demonstrated organizational skills and attention to detail.
• Proficient with electronic medical records.
• Experience leading a high-volume outbound outreach team.

Responsibilities

• Provide day-to-day clinical leadership to the CCM team.
• Launch and develop CCM program workflows and documentation standards.
• Supervise CCM staff and promote accountability and quality patient interactions.
• Coordinate daily workloads and ensure timely patient outreach and follow-up.
• Communicate care plans, conditions, medications, and appointments to patients.
• Perform outbound patient outreach by telephone as needed.
• Review patient information and identify needs for escalation.
• Provide nursing guidance within scope of practice.
• Coordinate with providers to support continuity of care.
• Maintain accurate, timely documentation in the EMR.
• Monitor program measures related to engagement, outreach, and productivity.

Skills

RN license

5+ years nursing

Chronic care

Clinical assessment

Communication

Organization

EMR proficiency

Team leadership

Job description

• Employee Type FT Exempt
• Manage Others Yes

Company Overview:

Summit Spine and Joint Centers (SSJC) is a rapidly growing, multi-state spine and joint care organization providing integrated clinical, surgical, and imaging services. With locations across Georgia, North Carolina, South Carolina, and Tennessee, our care teams include IPS and Savannah Pain Management, all operating as part of the SSJC organization.

We are committed to collaboration, high-quality patient-centered care, and supporting our teams as we continue to expand.

Position Overview:

Summit Spine and Joint Centers is seeking an experienced full-time Registered Nurse (RN) to serve as the clinical lead for our Chronic Care Management (CCM) program.

This individual will help support the launch and ongoing development of the program while providing day-to-day leadership to the CCM team. The RN Lead will oversee patient outreach and care-coordination activities, provide clinical guidance, manage escalated patient concerns, and help maintain consistent standards for documentation, productivity, and patient service.

This is a Hybrid role - requiring in office @ Lawrenceville 3 days a week, with 2 days work from home options.

The ideal candidate combines strong clinical judgment with leadership experience and is comfortable managing a team that primarily supports patients through outbound telephone outreach. Experience in Chronic Care Management, case management, population health, hospital-based outreach, telephone triage, skilled nursing, assisted living, or another care-coordination environment is strongly preferred.

Essential Duties and Responsibilities:

• Provide day-to-day clinical leadership and operational support to the CCM team.
• Support the launch and continued development of the CCM program, including workflows, documentation standards, patient outreach processes, and escalation procedures.
• Supervise, coach, and support CCM team members while promoting accountability, consistency, and high-quality patient interactions.
• Help coordinate daily workloads and ensure patient outreach and follow-up activities are completed accurately and timely.
• Communicate with patients regarding care plans, chronic conditions, medications, appointments, symptoms, and other care needs.
• Perform outbound patient outreach and follow-up by telephone as needed.
• Review patient information and identify concerns requiring clinical intervention or escalation.
• Provide appropriate nursing guidance within the RN’s scope of practice.
• Manage complex patient situations and clinical questions escalated by members of the CCM team.
• Coordinate with providers and other members of the healthcare team to support continuity of care.
• Maintain accurate, timely, and thorough documentation within the electronic medical record.
• Help establish and monitor program measures related to patient engagement, completed outreach, documentation quality, productivity, and escalation resolution.
• Identify workflow issues and recommend practical improvements as the program grows.
• Partner with clinical, operational, compliance, and billing teams to support consistent and compliant CCM services.
• Assist with training and onboarding new members of the CCM team.
• Maintain patient confidentiality and comply with HIPAA, clinical standards, and organizational policies.
• Perform additional duties based on departmental and organizational needs.

Minimum Qualifications:

• Current, active, and unrestricted Registered Nurse license.
• Minimum of five years of professional nursing experience.
• Experience caring for or coordinating services for patients with chronic or complex medical conditions.
• Strong clinical assessment, critical-thinking, and escalation-management skills.
• Strong verbal and written communication skills.
• Demonstrated organizational skills and attention to detail.
• Ability to communicate professionally with patients, providers, team members, and organizational leadership.
• Comfortable working extensively within an electronic medical record and other healthcare technology platforms.
• Comfortable leading a team responsible for high-volume telephone-based patient outreach and follow-up.

Preferred Qualifications:

• Multistate Nurse Licensure Compact license or eligibility to obtain multistate privileges.
• Previous Chronic Care Management experience.
• Previous hospital case management, population health, or care-coordination experience.
• Previous telephone triage, RN phone-line, or outbound patient-outreach experience.
• Previous direct people-management, supervisory, or team-lead experience.
• Experience working in a hospital system, skilled nursing facility, assisted living facility, centralized care-management department, or clinically focused call-center environment.
• Experience establishing or improving clinical workflows, documentation standards, performance expectations, or quality measures.
• Familiarity with CCM documentation, care-planning, patient-engagement, and time-tracking requirements.
• Clinical experience in ICU, medical-surgical, emergency medicine, or another acute or complex-care environment.

Professional Expectations:

• The employee must communicate professionally, respectfully, and effectively with patients, visitors, clinicians, coworkers, and vendors, including during busy, demanding, or stressful circumstances.
• The employee must maintain professional composure and consistently perform assigned duties throughout the scheduled work period; manage routine workplace stressors and feedback without disrupting patient care, patient-facing operations, or coworkers’ work; and use established de-escalation and escalation procedures when appropriate.
• The employee must exercise sound judgment, maintain appropriate workplace boundaries, receive and respond to routine feedback and direction, protect confidential patient and business information, and address patient or workplace concerns through established supervisory and safety procedures. These functions are essential to the position.