Columbia - MUSCP

Medical University of South Carolina

1d•Hybrid

About The Position

The role of the Patient-Centered Medical Home (PCMH) Care Coordinator is to work collaboratively with the physicians, staff and other health care professionals to actively facilitate health care delivery and promote care team communication for an assigned patient population ensuring appropriate care is provided. This position will be remotely based, in the Midlands/Columbia area. This position will be required to round in clinics 1-2 days per month.

Requirements

Certified Medical Assistant: High school diploma or equivalent.
Completion of an accredited medical assisting program with one year of patient care experience preferred.
Basic computer skills required.
Possess ability to understand and implement a variety of detailed instructions in the execution of therapeutic procedures and ability to make accurate physical observation of patients.
Employee must possess considerable knowledge of basic medical terminology and human anatomy; ability to understand and implement a variety of detailed instructions in the execution of complex therapeutic procedures; and ability to make accurate physical observation of patients.
Must communicate effectively both verbally and in writing.
LPN: Completion of a recognized Licensed Practical Nursing program.
Ability to demonstrate commitment to patient centered care philosophy as evidenced by effective communications skills, professional demeanor, and excellent interpersonal skills.
Ability and motivation to articulate and support departmental philosophy of excellent guest relations.
Must communicate effectively both verbally and in writing.
Must be computer literate.
Must be certified through the American Medical Technologist (AMT) or American Association of Medical Assistants (AAMA) or National Health career Association (NHA) or MedCA as a Certified Clinical & Administrative Medical Assistant (MA1), or National Association for Health Professionals (NAHP), or National Center for Competency Testing (NCCT).
Current American Heart Association (AHA) Basic Life Support (BLS) certification or American Red Cross BLS for Healthcare Providers certification is required.
Licensed as an LPN within the state of South Carolina or a compact state.
Current American Heart Association (AHA) Basic Life Support (BLS) certification or American Red Cross BLS for Healthcare Providers certification is required.

Nice To Haves

one year of patient care experience preferred.

Responsibilities

Identifying patients that qualify for care coordination: not meeting clinical goals and quality measures (i.e. hypertension and diabetic control) for patients, overdue for visits, labs, or referrals and arranging for follow-up services as appropriate, identifying gaps in care and respond with appropriate action to correct.
TCM coverage as needed.
Utilizes Epic registries and reports in accordance with process (i.e. CCM-weekly & daily, quality measures, etc.) to identify patients and needs.
Outreach to patients identified for care coordinator services (i.e. CCM, quality measures, etc.) & documents attempt(s) & completion.
Schedule services and places referrals in accordance with patient needs (i.e. vaccine, labs, appointment, mammogram, etc.).
Follow up as appropriate to track data.
Accurately maintains 100% of data received.
Communicates effectively and professionally with patients, care teams and providers to provide support for continuity of care between patient, care team, and assigned providers.
Compiles and summarize information for quality measures and projects.
Attend 80 % of staff meetings.
Maintains communication with providers & care team members (I.e. Epic inbox message, email, phone, office schedule, in person).
Identify patient needs and/or barriers (psychosocial and other) to care and coordinate patients/families contact with community resources.
Completes & documents accurate information gathering of data.
Completes Epic & community referrals as needed.
Communicates & follow up of identified barriers to the appropriate care team member/resource.
Other duties as assigned.