PCMH CMA Care Coordinator-Catawba

Medical University of South Carolina

About The Position

The role of the Patient-Centered Medical Home (PCMH) Care Coordinator works 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.

Requirements

5 years of relevant medical office experience required.
CMA Required
Must be certified through American Medical Technologist (AMT), American Association of Medical Assistants (AAMA), National Healthcareer Association (NHA), National Association of Healthcare Professionals (NAHP), Medical Career Assessments (MedCA), Certified Clinical Medical Assistant (CCMA), 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.

Responsibilities

Identifying patients that qualify for care coordination: not meeting clinical goals and quality measures (i.e. hypertension and diabetic control) for CCM pts, overdue for visits, labs, or referrals and arranging for follow-up services as appropriate for CCM pts, chronic care management (CCM), identify 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.
Outreached to patients identified for care coordinator services (i.e. CCM, quality measures, etc.) & documents attempt (s) & completion
Scheduled services and places referrals in accordance with patient need (s) (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 patient (s), care team (s) 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