Care Continuum Partner

Lehigh Valley Health Network•Allentown, PA

21h•Onsite

About The Position

The Care Continuum Partner serves as the main liaison between patients, families, and the clinical team across the continuum of care. The role partners with patients and families to coordinate, navigate, and schedule care, including outpatient services, procedures, community resources, and transitions of care. The partner meets patients within the organization’s physical and virtual settings and helps address their care needs and care-compliance opportunities, including appointment scheduling and coordination of services inside and outside the organization. Working with the clinical team, the Care Continuum Partner supports pre-visit planning, referrals and intake, scheduling, pre-certification, follow-up, and record retrieval. The role coordinates complex appointments and care plans, provides clear preparation instructions, facilitates communication among care teams and services, and connects patients and families with relevant organizational and community resources. The partner also maintains patient records, manages visit authorization and referral requirements, and helps patients and families use patient portal and medical record technology.

Requirements

High school diploma or GED and commitment to advance education.
At least 2 years of experience interacting with patients, including performing at least some of the role’s core functions.
At least 3 years of experience working within a complex health system environment or related field.
High degree of accuracy and attention to detail.
Enhance skills through continuing education.
Ability to handle numerous tasks at the same time.
Superior customer service skills.
Working knowledge of basic computer functionality.
Effective and professional written and verbal communication skills.
Ability to support patients and families in stressful situations.
Ability to maintain strict confidentiality.
Ability to adapt to changing priorities.
Critical-thinking skills and a solutions-focused approach.

Nice To Haves

Technical school diploma, specialized diploma, or associate’s degree.
Knowledge of and experience with electronic medical records and scheduling software.
Knowledge of medical terminology.

Responsibilities

Collaborate with the clinical care team on pre-visit planning to support smooth operations and patient flow in a busy physician practice.
Support referral management and intake, scheduling, pre-certification, follow-up calls, and record retrieval for timely appointments.
Coordinate and schedule complex appointments across the continuum of care, including procedures, office visits, diagnostic testing, labs, imaging, surgery, new-patient coordination, and therapeutic care plans.
Assess patient and family needs and support compliance with care plans through intake and outreach about care and appointment needs.
Communicate with patients through telephone, patient portals, and other applicable virtual platforms.
Facilitate communication among physicians and providers, the clinical team, and financial, outpatient, ancillary, and support services.
Provide clear instructions for preparing for tests and procedures and explain what to expect upon arrival, following established guidelines.
Provide patients with a care continuum plan and explain the necessary elements of care.
Create a warm and welcoming environment for patients, families, and staff through customer service and compassionate care.
Connect patients and families with organizational and community resources, including financial counseling, transportation support, social work, counseling, nurse navigation, nutrition services, and support groups, based on social determinants of health.
Support the care team’s assessment of social determinants of health and other community and psychosocial needs.
Create and maintain patient records and manage visit prior authorization and referral requirements.
Serve as a patient and family resource for patient portal and medical record technology, including providing virtual care concierge assistance when appropriate.