Coordinates team-based care to provide health services to individuals, through effective
partnerships with patients, their caregivers/families, community resources and their
physician/care team. Facilitates a “shared goal model” within and across settings to achieve
coordinated high-quality care that is patient and family centered.

Continued employment and raises in this position are dependent upon Central Montana
Medical Center's fiscal viability and:•
Actions and communications that contribute to a team concept and create a
positive environment for all customers•
Acceptable performance of essential and all job duties•
Acceptable attendance record•
Accountability for safety to self, patients, visitors and all customers, and care of
equipment and building•
Adherence to departmental and facility policies and procedures, education
requirements, compliance monitoring and reporting, and CMMC Code of
Conduct•
Accountability for the consequences of own actions•
Physical and emotional ability to perform essential functions•
Acceptable background investigation results if required for position
Minimum Education, Experience, Licensure, Certification required:
1. High school diploma or equivalent.
2. Certified Medical Assistant, Certified Nursing Assistant, or Community Health Worker certificate

required
3. Strong interpersonal skills.
4. Strong organizational skills and advanced computer skills.
5. Must be able to handle multiple duties concurrently and be able to work in a team environment.
6. Sufficient prior healthcare experience and expertise to navigate the healthcare system and

community resources.
ESSENTIAL FUNCTIONS/DUTIES:
(Must be able to perform with or without accommodation)
1 Maintain established departmental policies and procedures, objectives, quality assurance

program, safety, environmental and infection control standards.
2 Cooperate with other personnel to achieve department objectives and maintain good

employee relations, interdepartmental objectives, and infection control policies.
3 Serve as the contact point, advocate and informational resource for patient, family, care team,

payers & community resources.
4 Initiate routine check-ins with identified high-risk patients and direct clinical questions to

appropriate care team members.
5 Assist in connecting patients to resources to overcome barriers to care, including financial

assistance, transportation, housing and employment assistance.
6 Generate mailings & coordinate other targeted patient outreach efforts.
7 Assist with rooming patients for behavioral health providers.
8 Gather appropriate documentation for referrals to outside providers and specialists & follow up

to ensure patients are scheduled and records are sent back to referring provider.

9 Perform pre-visit planning prior to primary care appointments for identified patients to ensure

that all health needs are met.
10 Ensure effective tracking of patient appointments & assist in scheduling necessary follow-up.
11 Is adherent with CMMC’s policy on strict patient confidentiality guidelines and meticulously

OCCUPATIONAL EPOSURE for this position:
Category I Direct contact with blood or other bodily fluid to which

universal precautions apply
Category II Activity performed without blood/bodily fluids exposure,

but exposure may occur in emergencyCategory III Task/activity does not ordinarily entail predictable

exposure to blood/bodily fluids
OTHER EPOSURE for this position:

Radiation
Noise
Other (Specify)

PHYSICAL DEMANDS:
(Essential functions strength rating for position - see Job Analysis)

Sedentary Exert up to 10# occasionally or negligible force frequently
Light Exert up to 20# occasionally, < 10# frequently or

negligible force constantly
Medium Exert up to 50# occasionally, up to 25# or up to 10#

constantly

Heavy Exert up to 100# occasionally, up to 50# frequently or up

to 20# constantly
Very Heavy Exert > 100# occasionally, > 50# frequently or

> 20# constantly