Patient Care Coordinator (Primary Care, Lake Nona Town Center)

Nemours primary care practices provide a kid-friendly, family-centered pediatric primary care experience for families in Central Florida. With 18 primary care and three urgent care practices conveniently located throughout the region, we provide quality, professional pediatric services with special attention on preventive care and whole-child wellness.

The position is responsible for the following:

• Assists all patients referred for care coordination in navigation of the healthcare system by acting as a patient advocate and health care facilitator.
• Participates in all aspects of Patients Centered Medical Home
• Facilitates patient Health and Disease education
• Supports patient self -management of disease and behavior modification interventions.
• Coordinates continuity of patient care with both internal and external healthcare organizations and facilities.
• Obtaining referrals and/or precertification's for assigned patients or specialties prior to the patient's scheduled service, ensure the insurance has been verified, and linked to the correct accounts with accurate documentation in the Epic system. All denied referral/precertification requests are communicated to the appropriate areas.
• Coordinates high risk patient care, including management of patients with multiple co-morbidities or high risk for readmission on to a hospital setting.
• Conducts comprehensive, preventive screenings for patients and/or assists all support staff in daily patient interactions as needed.
• Promotes communication among members of the care team.
• Helps in the development and execution of patient care plans.
• Participates on a team for data collection, health outcomes reporting, clinical audits, and programmatic evaluation related to the Patient-Centered Medical Home and Medical Neighborhood initiatives.
• Evaluates overall clinical care, utilizations of resources, and development of new clinical tools, forms and procedures.
• Actively participates in Chronic Care Management, documentation, and billing.
• Participate in all assigned activities related to HEDIS measures, Care Gaps, roster management or any assigned function related to population management.
• Other duties as assigned.

• Associate degree required. Bachelor's or Masters degree in Social Work preferred.
• Specialized (1 year of training beyond high school) required.
• Three years of experience in insurance verification, scheduling, and patient care considered in lieu of degree.
• Certified Medical Assistant and State of Florida LPN or RN License preferred.
• Bilingual Preferred.
• Travel required to all Primary Care locations as needed.