Chronic Care Nurse

Job overview

The Chronic Care Nurse role is onsite in Roseburg, OR. Compensation is not specified. Evergreen Family Medicine provides outpatient family medicine and related services, with clinics in Roseburg and Myrtle Creek. The nurse coordinates chronic-care and clinical case management to support patient-centered care and improve outcomes across the care continuum. The role assesses patient and family needs, coordinates care and resources, monitors care plans, and provides or assists with diabetes education, smoking cessation, and wound care management.

What you'll do

• Coordinate case management from admission through discharge and follow-up, including emergency-room follow-up
• assess patient and family needs
• identify patients appropriate for chronic-care management and seek authorization
• coordinate care and resources
• develop and monitor care goals
• document quality and progress
• help address medication funding and insurance issues
• communicate delays and changes to the healthcare team
• provide or assist with diabetes education, smoking cessation, and wound care
• visit patients in care facilities
• and follow HIPAA and organizational policies.

What we're looking for

Skills & competencies

chronic care nurse

roseburg or

evergreen family medicine

chronic care management

case management

patient advocacy

care coordination

diabetes education

smoking cessation

wound care

lpn

rn

hipaa

Work arrangement

• Weekend coverage required

Benefits & perks

• Health, dental, and vision benefits
• life insurance
• 401(k) with company match up to 6%
• paid time off.

Why this role

Requires an LPN or RN degree, license, or certification; includes visits to patients in care facilities.

About the employer

Evergreen Family Medicine is hiring for this role. Industry: Offices of Physicians (except Mental Health Specialists). Sector: 62.