Senior Care Coordinator - Population Health

Overview

At Houston Methodist, the Senior Care Coordinator position is responsible for providing technical, clerical assistance and data management support to the care management department staff to facilitate efficient utilization of resources and discharge planning including referrals management, communication and collaboration with post-acute care providers, access to agencies and other community resources and transportation. The Senior Care Navigator Coordinator position performs administrative clerical duties including but not limited to coordinating needed physician referrals and appointments, conditions and assisting with population health initiatives, demonstrating independent actions necessary to provide competent and professional assistance to meet the needs of interprofessional health care team and patients. This position coordinates, oversees, records and transmits information pertinent to the resource management of patients to next level of care providers and performs a wide variety of administrative duties of a higher complexity in support of Care Management operations. The Senior Care Navigator Coordinator position develops and provides training to Care Navigator Coordinators around daily process like documentation, quality metrics, referrals and patient communication. This position requires a highly motivated self-starter who possesses the ability to communicate effectively and build relationships quickly.

Houston Methodist Standard

PATIENT AGE GROUP(S) AND POPULATION(S) SERVEDRefer to departmental "Scope of Service" and "Provision of Care" plans, as applicable, for description of primary age groups and populations served by this job for the respective HM entity.

HOUSTON METHODIST EXPERIENCE EXPECTATIONS

• Provide personalized care and service by consistently demonstrating our I CARE values:
  • INTEGRITY: We are honest and ethical in all we say and do.
  • COMPASSION: We embrace the whole person including emotional, ethical, physical, and spiritual needs.
  • ACCOUNTABILITY: We hold ourselves accountable for all our actions.
  • RESPECT: We treat every individual as a person of worth, dignity, and value.
  • EXCELLENCE: We strive to be the best at what we do and a model for others to emulate.

• Practices the Caring and Serving Model

• Delivers personalized service using HM Service Standards

• Provides for exceptional patient/customer experiences by following our Standards of Practice of always using Positive Language (AIDET, Managing Up, Key Words)

• Intentionally collaborates with other healthcare professionals involved in patients/customers or employees' experiential journeys to ensure strong communication, ease of access to information, and a seamless experience

• Involves patients (customers) in shift/handoff reports by enabling their participation in their plan of care as applicable to the given job

• Actively supports the organization's vision, fulfills the mission and abides by the I CARE values

Responsibilities

PEOPLE ESSENTIAL FUNCTIONS

• Communicates in an active, positive and effective manner to all interprofessional health care team members and reports pertinent patient care and family data in a comprehensive and unbiased manner, listens and responds to the ideas of others.

• Works collaboratively and maintains active communication with Care Navigators, physicians, nurses, office staff and other members of the multidisciplinary care team to resolve problems that are identified during follow-up phone calls.

• Troubleshoots and directs calls and requests to appropriate individuals from patients, employees and clients while evaluating, documenting and managing their needs. Proactively acts as a patient advocate, responding to and working to resolve patient concerns.

• Designs, develops and implements training programs for new and existing employees to enhance the competency, performance and professional development. Role models accountability for improvement of department score for employee engagement.

SERVICE ESSENTIAL FUNCTIONS

• Assists and coordinates various functionality and utilization of patient, employee and client database including data entry, assuring database is kept up-to-date. Proactively contacts patients, employees and clients to arrange follow-up on process or outcome goals that are determined or required.

• Coordinates referrals and services, as ordered by Care Managers and providers, following department standards, for patients with community resources, communicating effectively with community agencies and service providers to facilitate care coordination and information sharing. Coordinates and arranges appointments for providers and patients fo