Care Coordinator (Patient Care Coordinator)

Minimal Qualifications/Experience/Skills:

• A high school diploma or equivalent from an accredited school/program required.
• Knowledge of medical terminology and systems a plus. Must be detailed oriented, organized and have the ability to multi-task and work in a fast-paced environment.
• Must possess excellent customer service and writing skills. Position requires computer literacy; prior electronic health records (EHR) experience strongly preferred.
• Prior experience as a Medical Assistant is strongly preferred; experience as an EMT, CNA or community health worker a plus.
• Prior work experience in a clinic, hospital or health care agency setting preferred.
• Flexible work schedule to meet clinic hours; reliable transportation to access other clinic sites as assigned.

Summary:
Under the supervision of the Care Coordination Manager, the Care Coordinator will be responsible for monitoring and coordinating the population health management activities at one or more clinic locations. The primary function of this position will be to coordinate health care services, in partnership with patients and care team members, across the continuum of care, in order to maximize and improve patient health outcomes. This position will primarily be assigned to one of CCHC's 3 clinics (either Roseland, South Holland or Calumet City) and may be required to work across clinics. Responsibilities:

• Track, monitor, and schedule follow up appointments for patients recently discharged from the hospital or ER
• Assist patients, in collaboration with the care team, with transitions to care, navigating health care services and linkage to community resources.
• Monitor and coordinate the flow of patient health information throughout the organization
• Collaborates with Nurses (RN’s/LPN’s)/Care Managers to identify and refer appropriate patients for complex care management.
• Timely and accurate completion of all requests for medical records
• Maintain a log/tracking process for all medical records requests
• Maintain confidentiality of all medical records by adhering to HIPAA guidelines when handling patient information and sensitive documents.
• Identify patients for care coordination via generating patient registries, MCO care gap lists, etc.
• Regularly collaborate, coordinate, and communicate with care team member(s) to resolve outstanding patient care related items (i.e. care gaps; outstanding referrals; follow up paperwork etc.).
• Assist with data collection and reporting for targeted clinical quality measures.
• Assist with closing the loop on outstanding referrals, diagnostic results (i.e. labs, x-rays), patient documents and consult reports by following up with patients, specialty providers, hospitals, health plans, community agencies, etc.
• Serve as a resource to the care team and other staff members on the collection and management of population data, patient outreach, tracking of patient progress, and generation of reports.
• Produce, maintain and input timely, accurate, and thorough documentation of all communication directly with and on behalf of patients within the EHR
• Implement and maintain department’s process for logging/tracking all patient outreach efforts made (i.e. record request follow up; appointment scheduling; etc.).
• Submit performance reports (i.e. patient outreach, completed medical records requests, etc.) to direct supervisor as requested
• Conduct timely patient outreach/engagement and follow up activities, via telephone, direct mailing, face-to-face and/or electronically, to new and established patients and to schedule/coordinate appointments as needed and assigned.
• Participate in Patient Centered Medical Home (PCMH) and quality improvement (QI) related activities as assigned.
• Complete chart abstractions on an ongoing basis and as needed
• Participate in chart audits and reviews as needed and assigned.
• Maintain professionalism at all times when communicating with patients, staff members, community partners, external agencies, etc.
• Adhere to all policies, procedures, and protocols of the agency and department.
• Attend meetings and trainings as scheduled.
• Meet individual and department targeted productivity goals, objectives and performance ratings.
• Participate in clinical and administrative huddles as assigned.
• Performs other duties as assigned.

Christian Community Health Center is an EOE.
As a non-profit organization, we expect our employees to work and perform within our mission, in order to have a harmonious work environment. Our mission is, “To provide high quality health care and related services to the community regardless of the ability to pay. Provide service in a manner which demonstrates in word and deed, the love of Jesus Christ.”