Chronic Care Management Nurse

Health Ministries Clinic•Newton, KS

About The Position

Health Ministries Clinic (HMC) is seeking a compassionate and detail-oriented Chronic Care Management (CCM) Nurse to join our integrated care team in Newton, Kansas. This is a full-time position offering the opportunity to support patients with ongoing health needs in a collaborative, mission-driven environment. As a key member of our care team at a Federally Qualified Health Center (FQHC), the CCM Nurse plays an essential role in coordinating care for patients with chronic conditions. In this role, you will work closely with providers and patients to develop care plans, monitor health progress, and ensure patients receive the resources and support they need to manage their health effectively.

Requirements

Associate or bachelor's degree in nursing required.
Current Kansas Registered Nurse (RN) license required.
Strong communication, organization, and patient education skills.
Ability to manage multiple tasks and maintain accurate documentation.

Responsibilities

Identify and enroll eligible patients in the Chronic Care Management program.
Develop and maintain individualized care plans for patients with chronic conditions.
Coordinate care between providers, specialists, pharmacies, and community resources.
Conduct regular patient outreach via phone or electronic communication to monitor health status and care needs.
Provide education on chronic disease management, medications, and healthy lifestyle practices.
Assist patients in accessing community resources and support services.
Document all patient interactions and care coordination activities in the Electronic Health Record (EHR).
Track and record time spent on CCM services in accordance with program and billing requirements.
Maintain compliance with HIPAA and confidentiality standards.