JOB SUMMARY

This position is for a Chronic Disease Care Coordinator, LPN who is responsible for coordinating care for patients with chronic diseases to support improved health outcomes, continuity of care, and engagement in preventive and primary care services in accordance with accreditation standards, federal, state and local regulations, organizational and departmental policies and procedures. Works within the medical practices to identify patients with care gaps, missed follow-ups, or unmanaged chronic conditions and facilitates outreach, education, and care coordination. The role supports chronic disease management workflows, preventive care initiatives, and transitions of care, with the goal of improving quality outcomes, reducing avoidable emergency department utilization, and strengthening patient engagement in primary care. Participates in activities that ensure the safe and efficient provision of care to neonate, infant, adolescent, and adult patient populations. This position reports to the Director of Medical Practices.

JOB QUALIFICATIONS

Minimum level of

Education:

Education level equivalent to completion of a Licensed Practical Nurse Program required.

Formal Training:

Knowledge of chronic disease management.

Licensure, Certifications & Registration:

Current license to practice professional nursing in the state of Georgia; BLS Provider certification required; Instructor certifications do not replace provider certification requirements.

Work Experience:

Three to five years clinical experience in primary care required.