Care Coordinator (Clinical Research Coordinator) - LEAP Program - Liver

Project Description: LEAP (Liver Education & Action Program) at Mount Sinai is dedicated to enhancing the treatment of viral hepatitis infections in New York City. With a focus on hepatitis B virus (HBV), hepatitis C virus (HCV), and the lesser-known hepatitis delta virus (HDV), LEAP aims to improve patient outcomes through comprehensive care coordination, addressing both medical and psychosocial needs. Viral hepatitis can cause cirrhosis, end-stage liver disease, liver cancer, and death. LEAP utilizes comprehensive care coordination to assist medical providers in improving overall outcomes related to treatment while reducing barriers to care.

The Care Coordinator will provide case management, education, outreach, collaboration, and logistical support to patients with HCV, HBV and HDV as they navigate the treatment process at Mount Sinai. 

• Develop relationships with patients and their caregivers as well as the medical team to promote interdisciplinary communication, continuity of care, and adherence to patients’ care plans. Provide a central point of contact and escalate concerns appropriately.
• Collect, manage, and input HBV, HCV, and HDV-related data into the REDCap database, ensuring data security and accuracy. Document encounters in the electronic medical record (EPIC).
• Promote and monitor appointment adherence through follow-up calls and letters.
• Conduct brief screenings and interventions for alcohol, substance use, and mental health issues.
• Administer pre-treatment readiness assessments to identify potential barriers to treatment.
• Provide comprehensive patient education on the natural history of viral hepatitis, transmission prevention, evaluation, treatment options, adherence, side effect management, and general healthy living practices.
• Offer referrals to internal and community resources, including primary care providers, social services, mental health, and substance use resources.
• Check in with patients after appointments with liver providers, addressing concerns, scheduling follow-ups, and providing assistance with insurance issues.
• Coordinate with pharmacies and providers to prepare prior authorizations for medications, as well as ordering, delivering, and dispensing medications.
• Provide adherence counseling and monitor patient-reported side effects via weekly calls, reporting to providers as needed.
• Accept and coordinate in-house and outside viral hepatitis referrals
• Assist linkage to care team by reaching out to previously screened positive patients who have not been treated. 
• Schedule appointments, accompany patients to on-site or off-site appointments when necessary, and obtain outside medical records as needed.
• Follow up on labs ordered by liver providers and review results for evaluation completion.
• Organize and administer program incentives (e.g. metrocards)
• Report to and meet with the Program Manager and Care Coordination Team Lead regularly.
• Attend team meetings, contribute to case presentations, and participate in problem-solving and process improvement discussions.
• Collaborate with community partners to develop and maintain viral hepatitis-related networks, fostering relationships for warm handoffs.
• Perform other duties as assigned.

 

• Bachelors degree ideally in Public Health, Social Work, Psychology, or related field. related field preferred or a combination of relevant research experience and education
• 0-2 years of research/human subjects experience; 1-2 years of experience in community health, case management, health education, or related field.
• Fluency in English and Spanish highly desirable; Russian, Mandarin, Cantonese, or French fluency also valued.
• Experience managing databases and summarizing data in tables and charts.
• Knowledge of community resources and healthcare processes and structures.
• Proficiency with personal computers, especially Microsoft Office Suite, databases, and electronic medical records (e.g. EPIC).
• Ability to function at high level remotely (i.e. from home via Zoom, etc.) on days not in a clinic setting
• Strong interpersonal and teamwork skills
• Excellent oral and written communication skills and attention to detail
• Strong independent judgment, problem-solving skills, and ability to thrive in a rapidly evolving environment
• Eagerness to learn and take on new tasks
• Must be authorized to work in the United States
• Must be able to travel to multiple clinics in various locations in New York City Monday - Friday. Currently, this role is hybrid on-site and remote. May return to fully on-site/clinic in future.
• Please submit brief responses (2-3 sentences each) to the following questions:
  • What would you hope to learn in this role?<