Chronic Care Management Specialist

Chronic Care Management Specialist — Fort Myers, FL

• Position Summary: We are seeking an experienced and compassionate Chronic Care Management (CCM) Specialist to serve as the primary point of contact for patients enrolled in CCM programs. You will help patients navigate care, improve outcomes, and support adherence to individualized care plans. Prior CCM experience, proficiency with eClinicalWorks (eCW), and a patient-centered approach are required.

• Key Responsibilities:

• Manage and coordinate care for patients enrolled in CCM programs.

• Conduct patient outreach via phone and other communication methods to encourage engagement.

• Develop, maintain, and update individualized patient care plans.

• Monitor patient progress and ensure compliance with physician-directed plans.

• Coordinate services and connect patients to community and medical resources.

• Accurately document patient interactions, care activities, and clinical updates in eClinicalWorks (eCW).

• Collaborate with physicians, nurses, caregivers, and staff to ensure continuity of care.

• Educate patients about chronic disease management, medications, appointments, and preventive care.

• Maintain confidentiality and comply with HIPAA and organizational policies.

• Support quality improvement initiatives to enhance outcomes and patient satisfaction.

• Required Qualifications:

• Previous experience in Chronic Care Management (CCM).

• Hands-on experience using eClinicalWorks (eCW).

• High school diploma or equivalent.

• Strong verbal and written communication skills.

• Excellent organizational, documentation, and time-management abilities.

• Ability to work independently and collaboratively within a healthcare team.

• Comfortable with frequent patient outreach and phone communication.

• Strong attention to detail and accurate recordkeeping.

• Compassionate, professional, patient-focused approach.

• Working knowledge of HIPAA regulations and confidentiality standards.

• Preferred Qualifications:

• Associate's or Bachelor's degree in Healthcare Administration, Nursing, Public Health, or related field.

• Additional experience in care coordination, case management, population health, or patient advocacy.

• Experience in primary care, family medicine, internal medicine, or specialty practices.

• Bilingual (English/Spanish) communication skills.

• Knowledge of Medicare Chronic Care Management guidelines and documentation requirements.

• Certification related to care coordination, medical assisting, or healthcare administration is a plus.

• Proven ability to build strong relationships with patients and providers.

• Physical Requirements:

• Ability to remain seated for extended periods while working on a computer and telephone.

• Frequent use of computer, keyboard, headset, and other office equipment.

• Ability to communicate effectively with patients, providers, and team members via phone and video conferencing.

• Ability to read, analyze, and accurately document patient information.

• Occasional standing, walking, bending, and reaching as needed in an office environment.

• Ability to maintain focus and productivity in a fast-paced healthcare setting.

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