Chronic Care Coordinator

The Chronic Care Coordinator supports The Center's quality improvement and patient care initiatives by coordinating services for patients with chronic conditions and preventive care needs. This position focuses on patient outreach, education, care coordination, and follow-up to improve health outcomes, close care gaps, and increase completion of preventive screenings while supporting future value-based care and Federally Qualified Health Center initiatives.

• Coordinate care for patients with hypertension, diabetes, and other chronic conditions.
• Identify and close preventive care gaps, including breast, cervical, and colorectal cancer screenings, diabetic eye exams, kidney health evaluations, annual wellness visits, andimmunizations.
• Conduct patient outreach and schedule appointments.
• Provide patient education and promote medication adherence.
• Review payer gap reports and assist providers in improving quality measures.
• Document patient interactions in the electronic health record.
• Collaborate with providers, nurses, medical assistants, and community partners.

• Knowledge of chronic disease management and preventive care.
• Strong communication and organizational skills.
• Experience with electronic health records.
• Ability to manage multiple priorities.

• Current Nevada LPN license required.

• Two years of clinical experience
• Experience in primary care, chronic disease management, or care coordination preferred.
• Bilingual English/Spanish

• Completion from an accredited practical nursing program

• Current Nevada Licensed Practical Nurse (LPN)
• Current CPR/BLS Certification

• Remain seated and work at a computer for extended periods.
• Use a computer, keyboard, mouse, and telephone regularly.
• Communicate effectively in person, by telephone, and via video conferencing.
• Occasionally stand, walk, bend, reach, and lift office materials.
• Lift and carry items weighing up to 10-25 pounds occasionally.
• Travel locally or overnight, if required by the position.
• Perform the essential functions of the job with or without reasonable accommodation.