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May 6, 2025 | The Unsung Heroes of CCM: How Nurses Drive Lasting Impact

May 06, 2025 – Jacksonville, FL

Managing multiple chronic conditions is no small task for patients or their providers. That’s why Chronic Care Management (CCM) was created: to improve long-term outcomes, reduce hospitalizations, and promote better quality of life for the millions of Americans living with chronic illnesses. But behind the success of every CCM program is a critical, often underrecognized, force: nurses. 

From care coordination to patient education, nurses are the ones driving the day-to-day impact that makes CCM effective, especially for high-risk, vulnerable patients who need consistent, compassionate outreach between office visits. 

 

The Constant in a Complex System 

The Institute of Medicine showed this reality, saying, “Nurses are being called upon to help patients manage chronic illnesses, thereby preventing acute care episodes and disease progression.” This isn’t theoretical — it’s playing out every day across practices, hospitals, and virtual care settings nationwide. 

In CCM, nurse care managers often serve as the most consistent point of contact for patients. They build trust, offer guidance, and help patients feel seen and supported — all while navigating the clinical and administrative demands of value-based care. 

 

The Reach and Responsibility of a CCM Nurse 

CCM nurses do much more than check boxes or follow scripts. Their work touches nearly every part of the care journey: 

Their ability to connect with patients makes CCM a lifeline for those managing conditions like diabetes, hypertension, COPD, and heart failure. It’s not uncommon for a nurse care manager to interact with hundreds of patients each month, tailoring each conversation to that individual’s goals, challenges, and care plan. 

 

More Than CCM 

Chronic Care Management is only possible because of the collaboration across nursing roles — from nurse practitioners and clinical nurse specialists to physician assistants, RNs, and LPNs. But the value of nurse care managers extends far beyond CCM. Their skills and clinical experience make them essential to: 

Through navigating complex discharge plans, assessing care gaps, or facilitating social referrals, nurses bring clarity and continuity to patients at every step. 

 

Making All the Difference 

Care managers are the heart of what we do. They serve as advocates, educators, problem-solvers, and lifelines — often building relationships that last for years. Their work is deeply personal, incredibly skilled, and always centered around improving lives. 

We’re proud to support a team of nurses who bring empathy, dedication, and clinical excellence to every patient interaction. And we’re grateful because without them, none of this would be possible. 

To every nurse: thank you for the care you give, the trust you build, and the difference you make every day. 

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