Clinical Outcomes Specialist

Who We Are

At Suvida Healthcare, we are not just caregivers; we're compassionate advocates dedicated to enriching the lives of our cherished seniors. As a Team Member with us, you will embark on a fulfilling journey where your skills and empathy converge to make a meaningful impact on the well-being of an underserved community and their families. Our multi-disciplinary primary care program is built to address the physical, behavioral, social, and cultural needs of Medicare-eligible Hispanic seniors. 

Celebrate diversity and inclusivity in a workplace that attracts, engages, values, rewards, and recognizes the unique needs and backgrounds of both, our patients and our team. We believe that a rich tapestry of experiences,  shared interests, and perspectives enhances the care we provide, making us a stronger, service-centered,  and more compassionate healthcare family and Employer of Choice!  Will you join us Suvidanos, to help achieve our Higher Purpose?

What Makes Us Unique

We are an empowered primary care team, clinical operations, and support team creating health equity through an exceptional clinical and consumer experience that improves the quality of life for the people, families, and neighborhoods we serve. We tailor our primary care program to the culture, language, social, and overall well-being of the seniors we serve. 

How We Work

Our Culture & Core Beliefs

• Earn Trust
• Building Relationships
• Creating Joy
• Doing Right
• Improving Every Day
• Moving Forward

Our Promise

• Purpose Driven Career
• Competitive Pay
• Best-In-Class Medical/Dental Coverage 
• Free Mental Health & Life Coaching for Team Members and their Dependents
• Holiday Time Off with Pay
• Paid Community Service Day
• Paid Parental/Family Leave
• Paid Bereavement Leave
• Generous Paid Time Off (PTO)
• 401k Retirement Plan with Company Match
• And much more....

What You’ll Do 

Position Summary

The Clinical Outcomes Specialist (COS) will play a critical role in managing patients with uncontrolled diabetes and hypertension. This individual will focus on supporting the clinical staff and patients through longitudinal management of patients and reinforcement of their care plans by various clinical teams – Primary care providers, pharmacists, nutritionists, etc. The COS will communicate with and coordinate between patients, clinical staff, and pharmacies daily to ensure visits, orders/labs, and medication changes flow smoothly and troubleshoot barriers as they occur.

Responsibilities

·       Manage a population of targeted diabetic and hypertensive patients using Suvida’s platforms and EMR.

·       Conduct telephonic outreach to patients, coordinate care, and facilitate engagement, with occasional in-person clinic visits as needed.

·       Schedule and coordinate lab draws, A1C kits, and CGM downloads - collaborating with clinic staff and following clinic-specific procedures.

·       Support medication adherence, motivational interviewing, and patient education, including basic nutrition coaching.

·       As needed, schedule and perform phlebotomy/venipuncture & vitals for in-person visits

·       As needed, schedule and perform in-home visits 

·       As needed, perform other duties as assigned

·       Collaborate with PCPs and Clinical Pharmacists and help patients (and their caretakers/family members) manage their care plans and escalating issues appropriately and timely.

·       Document all patient interactions and care coordination in the EMR.

·       Maintains education and basic knowledge of HEDIS/STARs measures

·       Maintains education and knowledge base of refills a