Care Ally Coordinator CMA/MA

Duly Health and CareWheaton, IL
1dOnsite

About The Position

Under the direction of the Site Physician(s), Care Ally RN, and Supervisor/Director of Care Management, the Value-Based Care Medical Assistant (VBC MA) serves as a key member of the interdisciplinary care team supporting high-risk and rising-risk patients within value-based care programs. The VBC MA functions at the top of their scope to support population health initiatives, quality measure performance, risk adjustment accuracy, and care coordination activities aligned with organizational value-based contracts (including programs supported by the Centers for Medicare & Medicaid Services and Medicare Advantage plans). The role combines direct patient care, proactive panel management, preventive care outreach, transitional care support, and structured documentation to improve clinical outcomes and reduce avoidable utilization.

Requirements

  • High school diploma or GED and completion of one of the following:
  • Accredited Medical or Nursing Assistant Program or
  • EMT-B
  • Equivalent experience.
  • Must be experienced in PC/keyboard skills and Microsoft office applications.
  • Must possess excellent communication and writing skills.
  • Must have the ability to plan, organize, and work independently; exhibits problem-solving skills.
  • Able to develop professional rapport with employees at all levels of the company.
  • Must be able to perform CPR when necessary.
  • Practices OSHA safety standards and complies with HIPAA at all times.

Nice To Haves

  • Preferred one-year experience in a medical setting such as a doctor’s office, hospital or long-term nursing facility.

Responsibilities

  • Patient and Appointment Preparation:
  • Performs pre-visit planning and chart preparation to support value-based care initiatives, including:
  • Identification of care gaps and screenings needed per quality metrics (e.g., mammogram, DEXA scan, colorectal screening, immunizations)
  • Review of open lab and imaging orders
  • Preparation for Annual Wellness Visits (AWV) and High-Intensity Care (HIC) visits
  • Review of recent hospitalizations or emergency department visits
  • Schedules and coordinates:
  • Monthly HIC visits
  • Specialist appointments
  • Preventive screenings aligned with quality metrics
  • Lab and imaging appointments
  • Performs Exams/Procedures:
  • Performs protocol-driven clinical monitoring to support chronic disease management and value-based quality outcomes. Obtains and documents vital signs including blood pressure, heart rate, respiratory rate, temperature, weight, BMI, and pulse oximetry. Performs point-of-care testing such as blood glucose monitoring and other ordered tests within scope.
  • Conducts repeat blood pressure checks for patients with elevated readings. Collects and documents home monitoring data, including patient-reported blood pressure readings, glucose logs, weight logs (for heart failure monitoring), and pulse oximetry readings when applicable.
  • Identifies abnormal findings and escalates to the Provider or Care Ally Nurse in accordance with established clinical protocols.
  • Quality Control Procedures:
  • Disposes of biohazardous waste according to OSHA standards. Cleans, disinfects, and/or sterilizes instruments and equipment in accordance with safety and OSHA standards.
  • Supports value-based quality initiatives by:
  • Tracking and following up on incomplete orders (labs, imaging, diagnostic testing)
  • Ensuring completion and documentation of preventive screenings
  • Assisting with quality audits and chart reviews as directed
  • Patient Documentation:
  • Utilizes appropriate EHR functions (including Hyperspace/Epic workflows, where applicable) to facilitate patient flow, panel management, and quality metric capture.
  • Documents patient information including medications, reasons for visit, vitals, screenings, and structured quality data elements.
  • Ensures lab, imaging, and diagnostic results are correctly documented and routed.
  • Pulls discharge reports from hospital portals and obtains medical records from hospitals not utilizing Epic or shared EHR platforms.
  • Completes documentation support for Transitional Care Management (TCM), Chronic Care Management (CCM), High-Intensity Care visits, and Annual Wellness Visits as directed.
  • Administers and documents Social Determinants of Health (SDOH) screenings as applicable.
  • Manages Incoming Communications:
  • Manages incoming faxes, in-basket requests, and electronic communications in a timely and organized manner.
  • Assists nurse and providers with medication refill workflows after appropriate review and approval.
  • Coordinates communication with pharmacies and specialists as directed.
  • Routes urgent or clinically significant communications to Provider or Case Management Nurse per protocol.
  • Other Duties as Assigned:
  • Performs other role-appropriate tasks as needed based on business needs.

Benefits

  • Comprehensive medical, dental, and vision benefits that include healthcare navigation assistance.
  • Access to a mental health benefit at no cost.
  • Employer provided life and disability insurance.
  • $5,250 Tuition Reimbursement per year.
  • Immediate 401(k) match.
  • 40 hours paid volunteer time off.
  • A culture committed to community engagement and social impact.
  • Up to 12 weeks parental leave at 100% pay and a financial benefit for adoption and surrogacy for non-physician team members once eligibility requirements are met.
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