Patient Care Coordinator/Medical Assistant

Benefits:

• Health insurance
• Opportunity for advancement
• Paid time off
• Training & development
• Vision insurance
• Wellness resources

About Us: The Good Shepherd Community Clinic, Inc. is building healthy people through whole-patient wellness and trauma informed care. Our proactive focus and integrated approach to caring for the whole person allows the GSCC to provide quality and affordable health, dental, and pharmaceutical care to thousands of patients each year without regard for socio-economic or insurance status. Good Shepherd team members are passionate about making a difference in our patients’ lives. We are a driven, focused, innovative, hardworking, respectful team that is focused on working as one to improve the lives of our patients. 
  Mission: The GSCC exists so that the working poor and others who lack healthcare access receive quality care and improved health outcomes.
  Vision: Empowering Well-Being 

Core Values: Love, Respect, Fight, Resilience and Flexibility 
Job Overview: The Care Coordinator plays a critical role in supporting patient-centered care by proactively managing an assigned provider's patient panel. This position ensures patients receive timely, coordinated, and preventive care by conducting outreach, closing care gaps, scheduling appointments, and helping connect patients to internal and external resources. The Care Coordinator supports quality improvement goals and value-based care outcomes through consistent patient engagement and data-informed decision-making. 
Why Work With Us:

• Collaborative Care Teams: Work alongside a multidisciplinary team of healthcare professionals in a supportive and dynamic environment.
• Patient-Centered Care: Focus on building meaningful relationships with patients, guiding them through their healthcare journey.
• Community Impact: Make a tangible difference in patients' lives by ensuring they receive the care they need, regardless of financial or social barriers.
• Professional Growth: We believe in empowering our team members to develop their skills and advance within the organization.

  What You'll Do 

• Panel Management & Outreach 
  • Actively manage a panel of patients for an assigned provider
  • Reach out to patients who are due or overdue for:
    • Annual Wellness Visits (AWVs)
    • Preventive screenings and immunizations
    • Chronic disease follow-ups
    • Pediatric and adult return visits
    • Schedule visits and track follow-up completion
• Care Gap Closure
  • Review care gap dashboards and population health reports
  • Contact patients with open gaps and document outreach in the EHR
  • Coordinate with referrals and clinical teams to ensure follow-up
• Patient Engagement & Navigation
  • Be the first point of contact for care coordination needs
  • Help patients access services like behavioral health, pharmacy, and social supports
  • Conduct Social Determinants of Health (SDOH) screenings and refer internally as needed
  • Support completion of Health Risk Assessments (HRAs)
• Documentation & Data Integrity
  • Accurately log patient interactions, education, and scheduling in the EHR
  • Follow standard templates and workflows for consistency
  • Monitor and update patient panel lists and documentation status
• Team Collaboration
  • Participate in daily/weekly team huddles
  • Communicate with providers, referral coordinators, and clinical staff
  • Escalate high-risk or complex needs to RN Care Managers 

What Success Looks Like
Your performance will be measured by your ability to:

• Complete HRA and SDOH screenings
• Improve preventive care scheduling rates
• Reduce no-shows and boost patient re-engagement
• Close care gaps and ensure patients stay connected to their assigned provider 

What You’ll Need to Succeed
 

• Education & Experience
  • High school diploma or equivalent required; Associate’s degree preferred
  • 1+ year experience in care coordination, case management, or a medical office
  • Familiarity with EHR systems and scheduling workflows is a plus
  • Experience in FQHC, PCMH, or value-based care settings is highly valued
• Skills & Attributes
  • Excellent communication and people skills