Care Coordinator

OPSAM HEALTH•San Diego, CA

11d

About The Position

This position is responsible for Orienting and educating patients and their families by meeting them; explaining the role of the patient care coordinator; initiating the care plan; providing educational information in conjunction with direct care providers related to treatments, procedures, medications, and continuing care requirements

Requirements

Medical Assistant Program completion REQUIRED
Minimum of 3 year of professional level medical assistant experience; experience in care coordination preferred.
Experience working with an electronic medical record required.
Ability to work collaboratively with people of diverse cultures and lifestyles.
Ability to communicate effectively with providers and medical staff.
Excellent organizational skills and ability to handle multiple priorities while remaining calm and professional.
Ability to be self-motivating and work independently.
Computer literacy.
Excellent written and oral communication skills.
Problem solving skills.

Responsibilities

Orients and educates patients and their families by meeting them; explaining the role of the patient care coordinator; initiating the care plan; providing educational information in conjunction with direct care providers related to treatments, procedures, medications, and continuing care requirements.
Provide Medical Assistant coverage to the Podiatry Services and float when needed.
Provide transportation services on an as needed basis only after all other resources have been exhausted.
Assists patients with their mobility concerns as needed.
Assists all patients through the healthcare system by acting as a patient advocate
Leads and participates in daily care team huddle to assist in pre-visit planning and identifying patients who may benefit from an integrated visit with care management/coordination services.
Coordinates continuity of patient care with patients and families following hospital admission, discharge, and ER visits.
Manages Population Health and Disease Care Gaps in conjunction with Hedis team
Facilitates health and disease patient education,
Supports patient self-management of disease and behavior modification interventions.
Monitors high utilizers of services.
Addresses Preventative health—including school located flu clinics.
Manages high risk patient care, including management of patients with multiple co-morbidities or high risk for readmission to a hospital setting.
Assists population health with data collection, health outcomes reporting, clinical audits, and programmatic evaluation related to the Patient Centered Medical Home initiatives as appropriate.
Performs job utilizing the policy, protocols and standing orders for delivering care coordination.
Documents patient records using an Electronic Health Record.
Participates in Patient Centered Medical Home team meetings and quality improvement initiatives.
Assists both Quality & Compliance in improving the policy/procedures for the Clinical staff including Mas and Providers
Performs other duties as assigned