Value-Based Care Clinical Coordinator

The responsibilities of this job include, but are not limited to, the following:

• Assisting Nurse Care Managers (NCMs) by facilitating outside specialty referrals, scheduling diagnostic testing, or aiding in collaborative care efforts as directed;
• Coordinating external clinical resources efficiently according to NCM directives and care plans using the resources available;
• Collaborating with department leadership to support and improve the effectiveness and efficiency of clinical practices and processes;
• Understanding the electronic medical record system, NCM module, and payer-specific systems;
• Developing and maintaining strong relationships with patients, Patient First Physicians, ancillary staff, and external clinical support resources to ensure continuity of care;
• Conducting telephonic outreach to patients to encourage clinical gap closure, including: Providing telephonic advice per Patient First and Value-Based Care-specific
• instructions, maximizing the patients’ health, wellness, safety, and self-care capabilities by closing care gaps and helping with coordination of patient self-care needs, and scheduling and facilitating conversations with NCMs;
• Educating patients and caregivers on the importance of specified preventive or chronic care gaps;
• Assisting patients with appointment scheduling; conducting follow-ups with patients to ensure compliance with recommendations and follow-up appointments as needed;
• Coordinating any necessary clinical information to support specialist appointments and transitions of care between in-patient, specialty, and primary care settings;
• Communicating necessary patient updates, escalating clinical needs, and ensuring an effective handoff has been made to the assigned NCM;
• Facilitating the transfer of all urgent and emergent calls to an NCM or the Quality
• Improvement Committee (QIC) Project Director;
• Developing a list of medical and community resources available to patients and maintaining collegial relationships with frequently used organizations;
• Facilitating continuity of care on behalf of the patient to ensure successful closure of care gaps;
• Fostering positive relationships with and effective communication between Patient First, consulting physicians, hospitals, and other frequently used health care resources;
• Assisting with the day-to-day operations and administrative needs of the NCM department;
• Completing assigned checklists within the assigned shift;
• Receiving and storing supplies, as well as restocking the NCM area as needed;
• Attending staff meetings as scheduled by the NCM Supervisor;
• Handling NCM requests in a timely manner;
• Operating and maintaining office equipment as trained.

Minimum education and professional requirements include, but are not limited to, the following:

• Must be eighteen years of age or older;
• Associate degree preferred with at least 3 years of experience as a Medical Assistant, preferably within a Patient First center;
• Experience in scheduling appointments with multiple providers, including diagnostic testing;
• Ability to work in a team-oriented environment and be highly organized;
• Ability to work and communicate effectively with all levels of administrative and professional personnel;
• Exceptional oral, written, and telephonic communication skills;
• Self-disciplined, self-directed, motivated, energetic, passionate, and innovative;
• Must be able to sit, stand, and walk for long periods of time.