Medical Assistant Care Coordinator (DHWC)
About The Position
The Medical Assistant Care Coordinator supports the patient-centered medical home (PCMH) model by working closely with the Care Coordination RN/LVN and the integrated care team. This role focuses on patient engagement, care coordination, follow-up support, and health outcomes improvement in both clinic and home settings. This position directly impacts patient care continuity, outcomes, and experience by supporting clinical workflows, coordinating referrals, monitoring patient needs, and improving access to care. While the role has no direct budgetary or supervisory responsibility, it significantly influences patient satisfaction and clinical effectiveness across assigned patient populations. Operates under established protocols and supervision. Uses judgment in monitoring patients, escalating clinical concerns, and coordinating care. Exercises discretion in prioritizing tasks and responding to patient needs in clinic and home visit settings.
Requirements
- High school diploma or GED; graduation from an accredited Medical Assistant program.
- Currently registered with the Texas Department of Aging and Disability Services, National Association for Health Care Professionals, or National Healthcare Association.
- Current BCLS certification.
- Minimum of one (1) year in a clinical setting.
- Must have a valid driver's license, access to a reliable vehicle, and current auto liability insurance.
- Bilingual fluency in English and Spanish required.
- Basic proficiency with Microsoft Office (Outlook, Word, PowerPoint, Excel) and internet usage.
Nice To Haves
- Experience with electronic health records (EHR).
- Previous experience in community health or with vulnerable populations.
- Experience coordinating care across multiple providers or health systems.
- Additional certifications in community health or care coordination.
- Experience using Electronic Health Record (EHR) systems.
Responsibilities
- Collaborate with Care Coordination RN/LVN and healthcare team to promote PCMH principles and seamless care.
- Coordinate follow-up care after ER visits, including scheduling appointments, assisting with medication needs, and specialty referrals.
- Provide education and navigation support to patients and families regarding ongoing care and conditions.
- Conduct home visits to assess patient needs, support care plans, and promote health outcomes.
- Monitor and respond to changes in patient condition in-person, by phone, or during home visits.
- Assist with transition of care to ensure continuity between healthcare settings.
- Respond to patient inquiries, complaints, and requests; provide resolution or escalate as appropriate.
- Occasionally take and document vital signs both in clinic and home settings.
- Document patient outcomes using accurate clinical terminology.
- Perform other duties as assigned to support the integrated care team and patient population.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
Number of Employees
101-250 employees
