What are the responsibilities and job description for the Senior Ambulatory Care Coordinator position at Regional One Health?
Senior Ambulatory Care Coordinator
A Brief Overview
Acts as principal liaison between Ambulatory Clinics, physicians, Managed Care Organizations, patients and other members of the multidisciplinary team to ensure gaps in care are closed. Includes, responsible for identifying and facilitating "Gaps in Care" (GIC) services for patients in need of enhanced Care Coordination services. Also responsible for assisting the Care Team with the tracking and coordination of timely, high quality and efficient health care and support services as identified through a multi-disciplinary care plan, self-management goals and referrals to both internal and external resources. Provides administrative support by performing appointment outreach, facilitating referrals, updating patient information in medical records and assisting with data collection, aggregation and analysis activities. Providers EMR support for documentation and education as needed to close gaps in care and met regulatory compliance. Trains care coordinators and services as administrator for MCO websites and other activities.
What you will do
- Perform stratification of member populations into targeted subsets, using information collected through population assessment and other data sources, aimed at health promotion and wellness, management of chronic conditions and complex case management.
- Perform continuous Quality and Performance Improvement activities as assigned.
- Maintain surveillance ticklers and/or work with Health Information Technology (HIT) to proactively identify the need for patient care and outreach as assigned.
- Track and support patients when they obtain services outside the practice like Emergency Departments, Hospitals and other health care facilities.
- Follow-up with patients as prescribed after an emergency department (ED) visit or hospital discharge.
- Work with patients both in person and over the phone to remind and review their plan of care and progress towards their goals.
- Assist patients with the process of determining eligibility, obtaining and maintaining free pharmaceuticals through the internal pharmacy subsidy program.
- Collaborate with other members of the Care Coordination and Management team for activities including assistance with implementation of Care Plan.
- Manage referrals, when needed, to appropriate agencies required to assist the client in achieving the goals and objectives identified in their Care Plan.
- Identify and utilize cultural and community resources.
- Establish and maintain relationships with identified service providers.
- Assist with data collection and generation of patient registry reports.
- Ensure timely documentation in the Electronic Health Record (EHR).
- Demonstrate excellence in both internal and external customer service.
- Understand and effectively communicate HIPAA compliance, corporate compliance and client confidentiality.
- Ensure and/or remain in compliance with local, state, and federal regulation.
- Adhere to the National Patient Safety Goals as defined by Joint Commission and adopted by Ambulatory Administration and Services.
Qualifications
- Graduate of an approved Certified Medical Assistant Program Required and
- Associate's Degree Required
- LPN - Licensed Practical Nurse - State Licensure Upon Hire Required or
- Certified Medical Assistant (CMA)-AAMA Upon Hire Required and
- Cardiopulmonary Resuscitation (CPR) Upon Hire Required or
- Minimum 2 years experience Clinical nursing experience in a medical office Required and
- Leadership experience Required and
- NCQA/PCMH, HEDIS CPC experience Preferred
Physical Demands
- Standing - Constantly
- Walking - Constantly
- Sitting - Rarely
- Lifting - Frequently
- Carrying - Frequently
- Pushing - Occasionally
- Pulling - Occasionally
- Climbing - Occasionally
- Balancing - Occasionally
- Stooping - Frequently
- Kneeling - Frequently
- Crouching - Frequently
- Crawling - Occasionally
- Reaching - Frequently
- Handling - Frequently
- Grasping - Frequently
- Feeling - Constantly
- Talking - Constantly
- Hearing - Constantly
- Repetitive Motions - Constantly
- Eye/Hand/Foot Coordination - Constantly
Regional One Health is committed to diversity and inclusion. We are an equal opportunity employer including veterans and people with disabilities.
