Pinehurst Medical Clinic offers comprehensive chronic care management services to Medicare patients with two or more chronic conditions who would benefit from having a dedicated nurse care manager. Our nurse care managers work closely and diligently with the patient's Pinehurst Medical Clinic primary care provider. This collaboration ensures seamless and convenient communication is occurring on behalf of the patient.
Nurse care managers provide the following to chronic care management patients:
- Offers support and coaching over the phone to assist with health-related concerns
- Identifies and secures community resources that would benefit the patient
- Keeps in regular contact with the patient to ensure care plans and goals are exceeded
- Assists with medication management
- Serves as a liaison between patients and their healthcare teams
- Provides resources to help navigate the decision-making process
In addition to chronic care management, Pinehurst Medical Clinic offers transitional care management, to those patients needing assistance with the lifestyle changes after a hospitalization. This team works with patients up to 30 days after a hospital discharge to help patients with the following:
- Education on disease processes
- Provide community resources and referrals
- Assistance with medications
- Collaboration with those involved in the patient's care journey
By providing the above assistance, Pinehurst Medical Clinic Chronic Care Management and Transitional Care Management teams help to reduce the likelihood of readmission and emergency department visits.
For more information about Pinehurst Medical Clinic's ChronicCare Management and Transitional Care Management programs, please talk to your provider or call 910-235-3367.
Chronic Care Management Conditions & Diseases
Pinehurst Medical Clinic Chronic Care Management helps patients with multiple diseases and conditions. They do this by being an advocate for the patient's health and teaching them ways to manage their conditions to live a happy and full life.
Some diagnoses the chronic care management team helps patients with include:
- Diabetes
- Hypertension
- Congestive Heart Failure
- Chronic Obstructive Pulmonary Disease
- Chronic Kidney Disease
- Atrial Fibrillation
Our Chronic Care Management Team
Our exceptional chronic care management staff provides ongoing nursing care for patients with chronic illnesses or conditions.
Work for one of North Carolina's largest independent multispecialty health care organizations.
Pinehurst Medical Clinic is seeking individuals who share our commitment to offering compassion, embracing accountability, showing respect, and ensuring Pinehurst Medical Clinic is the choice for medical excellence by providing a high-quality patient experience to those we serve. If you're a healthcare provider interested in joining out team, visit our Careers center to learn more about current employment opportunities with PMC.
