The Chronic Care Management (CCM) online training provides learners with the necessary knowledge, tools, and resources to define, develop, and implement successful CCM programs in their clinics and organizations.

Register for the Nursing Modules

Nursing Modules:

  Recommended Attendees:

  • Population Health Nurses
  • Nurse/MAs 
  • Practice Mangers
  • Additional Care Management Team Members (e.g. Social Workers)
Training Outline and Learning Outcomes:

Lesson 1: Pre-Assessment and Disclosure Agreement

Lesson 2: Overview of Chronic Care Mangement
  • Discuss the roles and team members involved with Chronic Care Management (CCM)
  • Describe the key elements of a CCM program
  • Articulate the importance of a CCM program to your patients and clinic
Lesson 3: Care Teams and Team-Based Care
  • Explain the roles of each member of your care team
  • List tools and best practices that will help you identify opportunities for improvement for your team
Lesson 4: Enrolling Patients in Chronic Care Management
  • Describe which patients are eligible to participate in CCM
  • Explain how to develop a strategy for enrolling patients in CCM
Lesson 5: Chronic Care Management
  • Explain the key elements of a successful CCM program
  • Describe the overall workflow and requirements of CCM
Lesson 6: Achieving Care Plan Goals
  • Explain how to work with patients to create personalized care plans
  • Describe common obstacles and how to overcome them
  • List attributes of a good health coach
  • Explain where to get further health coaching training
Lesson 7: Complex Chronic Care Management
  • Explain the differences between CCM and Complex CCM
  • Describe the workflows needed to provide the right level of care management to the patient
Lesson 8: The Patient Experience
  • Identify your role in creating a holistic patient experience
  • Explain what is or isn’t communicated during visits
  • List ways to engage the patient and family
Lesson 9: Coding and Billing Chronic Care Management
  • Articulate the basic requirements for CCM
  • Explain the basics of billing CCM
  • List where to find additional resources for billing and coding CCM
Register for the Nursing Modules

Caravan Health is approved as a provider of nursing continuing professional development by The Mississippi Nurses Foundation, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation.

This activity has been approved for 3 nursing contact hours.

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Ancillary & Support Staff Modules:
Register for the Ancillary & Support Staff Modules

Support, code, and accurately bill for work your teams are already doing to support complex patients. Our proven approach enables the entire clinic team – from front to back office – to work at top-of-scope and support sustainable, ongoing, between-visit care for chronically ill patients. These flexible, on-demand modules operationalize the role of each care team member, empowering the entire team to support, deliver, code, and bill for chronic care management services.

  Recommended Attendees:

  • Front and back office staff
  • Billers/Coders
  • Any member of your team that may benefit from the modules 

  Training Outline:

Lesson 1: Overview of Chronic Care Management Training
Lesson 2: Care Teams and Team-Based Care
Lesson 3: Enrolling Patients in Chronic Care Management
Lesson 4: Coding and Billing Chronic Care Management
Lesson 5: ACO Core Program Training Summary

Register for the Ancillary & Support Staff Modules

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