Medical Assistant- Chronic Care Management Coordinator

Job Description

Job Description

Job Summary :

The Medical Assistant Chronic Care Management Coordinator will provide essential support to patients with chronic health conditions by delivering consistent, high-quality, and proactive care management. This role is pivotal in coordinating care, educating patients, and ensuring they have access to the resources necessary to manage their conditions effectively. The CCM Coordinator works closely with healthcare providers and other team members to improve patient outcomes, enhance compliance with treatment plans, and reduce hospital admissions or emergency visits.

Key Responsibilities :

• Patient Outreach and Engagement :

Conduct regular check-ins with enrolled patients via phone to monitor their health status, assess needs, and offer support.

• Educate patients on chronic disease management, including lifestyle changes, medication adherence, and self-care practices.
• Care Coordination :

Develop and maintain individualized care plans for patients, in collaboration with healthcare providers.

• Coordinate and schedule appointments, including follow-ups, labs, referrals, and preventive services.
• Serve as a liaison between patients and healthcare providers, assisting with communication and information sharing.
• Documentation and Record-Keeping :

Accurately document all patient interactions, interventions, and updates to care plans in the electronic medical record (EMR) system.

• Track patient outcomes, monitor key metrics, and prepare reports to evaluate the effectiveness of care management.
• Patient Advocacy and Support :

Assist patients in accessing community resources, financial assistance programs, and other services to support their care plans.

• Act as a patient advocate to ensure they receive the care and resources they need.
• Compliance and Quality Assurance :

Ensure all activities comply with relevant healthcare regulations, such as HIPAA and Medicare guidelines.

• Maintain up-to-date knowledge of best practices in chronic care management and participate in ongoing training.

Qualifications :

• Education : High school diploma or equivalent; associate or bachelor's degree in healthcare administration, nursing, or related field preferred.
• Experience : At least 1-2 years of experience in a healthcare setting, preferably in chronic care management, case management, or patient support roles.
• Skills :

Excellent communication and interpersonal skills to effectively engage with patients.

• Strong organizational skills and attention to detail.
• Proficiency in using EMR systems and Microsoft Office applications.
• Ability to work independently and as part of a multidisciplinary team.

Preferred Qualifications :

• Knowledge of chronic diseases, such as diabetes, hypertension, and COPD.
• Bilingual language skills to serve diverse patient populations.