Outreach Care Coordinator IHCI

Community Health Network•Indianapolis, IN

About The Position

Community Health Network was created by our neighbors, for our neighbors. Over 60 years later, “community” is still the heart of our organization. It means providing our neighbors with the best care possible, backed by state-of-the-art technology. It means getting involved in the communities we serve through volunteer opportunities and benefits initiatives. It means ensuring our dedicated caregivers can learn and grow to stay at the top of their fields and to better serve our patients. And above all, it means exceptional care, simply delivered — and we couldn’t do it without you. The Outreach Specialist Works closely with the RN Care Advisor to support and improve the Care Management processes. The Specialist will assist with care gap identification and closure through patient calls, EMR evaluation, and Payer Portal assessments. The Specialist will assist patients with scheduling any necessary exam or test to close gaps in care. Healthcare and health systems are complex and often confusing entities for patients. The Specialist will help patients participate in their own care and successfully navigate through the respective Health System Partner organizations.

Requirements

High School Diploma or GED (Required)
3+ years: Experience with medical/business computer applications in provider office or healthcare setting. (Required)

Nice To Haves

2 years/associate degree (Preferred)

Responsibilities

Assists with care gap identification and closure through patient calls, EMR evaluation, and Payer Portal assessments.
Assists patients with scheduling any necessary exam or test to close gaps in care.
Helps patients participate in their own care and successfully navigate through the respective Health System Partner organizations.
Assists Care Coordinators and RN Care Advisors in arranging post-discharge needs.
Arranges and/or assists with referrals for home care services.
Ascertains availability of and make timely transportation arrangements.
Schedules post-discharge appointments with providers such as PCP, specialists, therapists, etc.
Communicates with alternate level of care liaisons to identify an acceptable facility and to establish a timeline for transfer.
Arranges delivery of medical equipment as determined by hospital/post-acute procedure/policy.
Coordinates and schedules follow-up appointments, annual care visits, and other necessary evaluations for patients with appropriate physicians(s) and other health care providers.
Provide patients with the necessary information to make informed decisions.
Engages chronically ill patients in activities to improve their health with a focus on wellness and prevention of unnecessary utilization, such as emergency department utilization and acute care admissions.
Escalates care issues to the RN Care Advisor, when indicated.
Conducts calls to validate patient follow through and adherence to the care plan and recommendations as well as validating understanding of instructions.
Develop relationships with patient’s care management team and operate as an extension of the provider and RN Navigator to support chronically ill stable patients.
Ensure that required data is accurate and consistently captured in the EMR.
Performs RN Care Advisor delegated activities.
Serves as a patient advocate and point of contact for the patient to ensure continuity of care.
Supports various projects or work as business needs and goals change.