Care Continuum Partner

Lehigh Valley Health Network•Easton, PA

1d•Onsite

About The Position

The Care Continuum Partner serves as the main liaison among patients, families, and the clinical team throughout the continuum of care. The role partners with patients and families to coordinate, navigate, and schedule care across 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 opportunities for care compliance, with a focus on an optimal patient experience. Working with the clinical care team, the partner supports pre-visit planning and patient flow, manages referrals and intake, coordinates complex appointments and services, and conducts patient outreach. The role facilitates communication across clinical, financial, outpatient, ancillary, and supportive services; explains preparation and arrival instructions for tests and procedures; and connects patients and families with relevant organizational and community resources. The partner also maintains patient records, manages prior authorization and referral requirements, and guides patients and families in using the patient portal and medical record technology, including through virtual care concierge support.

Requirements

High school diploma or GED, with a 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 simultaneously.
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 and experience with electronic medical records and scheduling software.
Knowledge of medical terminology.

Responsibilities

Support pre-visit planning with the clinical care team to promote smooth operation and patient flow in a busy physician practice.
Assist with 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, imaging, labs, new-patient coordination, and therapeutic care plans.
Assess patient and family needs and support adherence to care plans through intake, outreach, and follow-up on care and appointment needs.
Communicate with patients through telephone, patient portals, and other applicable virtual platforms.
Facilitate communication among physicians and providers, clinical teams, financial services, outpatient services, ancillary services, and supportive services.
Give patients 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 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 patients’ 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 the patient portal and medical record technology, and provide virtual care concierge assistance when appropriate.