CMA - Care Coordinator

Located in:

The duties include, but are not limited to:

• Monitor and identify patients who are eligible for Transitional Care Management following hospital or qualifying post-acute discharge.
• Complete the required interactive contact with the patient and/or caregiver within the applicable TCM timeframe.
• Establish contact with patients and caregivers by telephone or other approved communication methods.
• Review and reinforce discharge instructions and identify questions, concerns, or barriers requiring attention by the care team.
• Confirm the patient's understanding of the discharge plan and follow-up recommendations.
• Identify medication-related concerns, access issues, or discrepancies and communicate them to the appropriate provider or clinical team member.
• Assist with arranging and confirming timely follow-up appointments with the primary care provider.
• Coordinate with providers, nurses, care managers, specialists, pharmacies, hospitals, and other healthcare entities as appropriate to support continuity of care.
• Identify potential barriers to a successful transition, including transportation, medication access, difficulty obtaining services, or other non-clinical needs, and communicate those barriers to the appropriate care team member.
• Escalate clinical symptoms, changes in condition, or other patient concerns to the appropriate licensed clinical staff or provider in accordance with established protocols.
• Track TCM patients and follow established workflows to ensure required activities are completed within applicable timeframes.
• Accurately document all patient contacts, assessments within scope, interventions, communications, and follow-up activities in the EHR/EMR.
• Support care team efforts to reduce avoidable emergency department utilization, hospitalizations, and readmissions.
• Assist with care-gap closure, preventive care outreach, chronic disease management activities, and other population health initiatives as assigned.
• Participate in care team meetings, huddles, and other activities related to patient care coordination.
• Maintain awareness of appropriate resource utilization and the total cost of care when coordinating services and supporting patient needs.
• Maintain patient confidentiality and comply with HIPAA, organizational policies, and applicable regulatory requirements.
• Perform other duties as assigned in support of the care team.

Qualifications or Education, Training and Experience

·         Certified or Registered Medical Assistant

·         At least 2 years of similar job experience in a medical office preferred

•         Familiar with EKG, Phlebotomy and Patient Care

Knowledge and Skills/Expected Competencies

• EHR and EMR systems. Basic PC skills (MS Word/Outlook/PPT/Excel)
• Ability to use independent judgment and to manage and impart confidential information.
• Ability to analyze and solve problems; requires details, data and facts.
• Ability to clearly communicate medical information to professional practitioners and/or the public.
• Strong organization, prioritization, follow up, and time management skills
• Good interpersonal skills, sense of urgency, being proactive and ownership for one’s work.
• Ability to deal with multiple interruptions on a continual basis must be met with a friendly exchange with others.

Featured Benefits:

• Health, dental, and vision insurance.
• 401K with automatic employer contribution.
• PTO and Paid Holidays.
• Company paid Life Insurance.
• Access to voluntary short and long-term disability insurance.
• Access to additional life insurance.
• Access to a variety of Wellness programs. 

The compensation range for this position is $19.00/hour– 26.00/hour. Compensation is based on the level and requirements of the role. 

Salary within our ranges may also be determined by your education, experience, knowledge, skills, abilities, and location, as required by the role, as well as internal equity and alignment with market data.