Chronic Care Coordinator

Job Description

Location: Durham, NC (Onsite)

We are partnering with a mission-driven healthcare organization in Durham, North Carolina, to hire a dedicated and detail-oriented Chronic Care Coordinator (CCM). This full-time, onsite position plays a critical role in delivering proactive care coordination to patients living with multiple chronic conditions.This role is ideal for a healthcare professional who brings strong organizational skills, clinical understanding, and a patient-first mindset. It’s a key opportunity for someone passionate about building relationships, improving outcomes, and supporting patients in managing their long-term health.

Responsibilities:

• Maintain consistent, monthly outreach to enrolled patients with two or more chronic conditions to assess health status, reinforce treatment plans, and offer education and support
• Create and update individualized care plans in collaboration with the patient, provider, and care team
• Serve as a liaison between patients, providers, specialists, pharmacies, and community resources to coordinate care
• Document all patient interactions, interventions, and care plan updates accurately and promptly in the electronic health record (EHR)
• Track progress toward goals, address care gaps, and escalate issues to clinical leadership as needed
• Ensure documentation meets CMS Chronic Care Management (CCM) program requirements and supports proper billing compliance

Qualifications:

• Associate or Bachelor’s degree in Nursing, Social Work, Health Sciences, or a related field preferred
• Minimum 2 years of experience in care coordination, case management, or chronic disease management
• Familiarity with chronic conditions such as diabetes, hypertension, COPD, and CHF, and with CMS CCM program guidelines
• Proficiency in EHR platforms and Microsoft Office
• Strong communication, time management, and follow-up skills
• CCM or Case Management certification preferred, or willingness to obtain within 12 months

Schedule & Work Environment: 

• Full-time, Monday through Friday
• Standard business hours (8:00 AM – 5:00 PM)
• On-site role based in Durham, NC
• Office-based, community-focused healthcare facility
• Collaborative care environment with clinical and administrative support
• No weekend or on-call responsibilities

Salary Range: The salary range for this position is $50,000 – $60,000 per year ($24.00 – $29.00 per hour), based on experience.

Interview Process:

1. Initial Phone Screen with the TalentLNX Recruiting Team
2. Second-Round Interview with the Hiring Managers (CCM Program Supervisor and or Clinical Operations Leader)
3. Final Onsite Interview with the Hiring Managers (CCM Program Supervisor and or Clinical Operations Leader)

Equal Opportunity Employer: TalentLNX is committed to equal employment opportunity and prohibits discrimination and harassment of any kind. We are dedicated to building a diverse workforce and fostering an inclusive work environment where all employees and candidates are treated with respect and dignity. We do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, genetic information, disability, or any other protected status under applicable law. We actively seek to recruit, develop, and retain talented individuals from diverse backgrounds, and we encourage all qualified candidates to apply for our job opportunities.