About Job

Title: Care Coordinator

Reports To: Chief Quality Officer

Supervision Exercised: None

Typical Working Conditions: This position requires patient contact; as well as to support the clinical care team in direct care of our patients.

Work Location: Split location between Cortland Family Practice 3 days/week and Homer Family Practice 2 days/week

Qualifications: Must have healthcare training (LPN, MA, Healthcare education). Must possess strong understanding of HIPAA rules and regulations, working knowledge of Microsoft Office, and Electronic Health Record (EHR). Strong organizational skills requested, along with knowledge, or ability to acquire knowledge of standard clinical benchmarks (HEDIS). Ability to maintain professional relationships along with a positive attitude.

Primary Function: The Care Coordinator works with the clinical care team as well as the Chief Quality Officer in improving coordination of care, for our patients. This position also requires strong verbal as well as written communication skills; individuals must be self-motivated and can act independently as well as part of the team.

General Summary of Duties:

· Management of patient tracking for laboratory tests, referrals for other diagnostic studies as well as referrals to consulting specialists.

· Identifies patients in need of clinical services for more intensive management based on evidence based clinical practice guidelines.

· Arranges for additional clinical services and/or testing for patients based on clinical practice guidelines

· Assists the Chief Quality Officer in chart audits as required for:

· Clinical data submissions to HRSA

· Clinical data submissions to payers for quality incentive programs

· Family Health Network’s own quality improvement program

· Development of clinical reports for any grant program as required

· Assists the direct care team in the provision of services to patients, particularly when this requires coordination with outside organizations.

· Identifying and referring patients to care management within the local Health Home.

· Follows up with patient’s to track self-management goal achievement and scheduling appointments when needed.

· The Care Coordinator is part of the patient care team. The care team is comprised of the patient, care coordinator, nurse, and provider. As part of the patient care team, the Care Coordinator will engage patients in their own health care. This will include supporting patients and their families in self-management and positive behavior change. This will require good communication which is both open and supportive.

· Assists in data management in the PCMH application process

· Provide self-management report and identifying appropriate community resources for at risk patients.

· This position requires compliance with Health Center’s written standards, including its Standards of Conduct and policies and procedures pertaining to all operational aspects, furthermore this position is required to report any suspected instances of noncompliance.

· This position will function as a contributing member of the emergency preparedness team under the incident command system.

· Perform other tasks as assigned.

· Maintain strictest confidentiality.

· This position will function as a contributing member of the FHN Dramatic Performance Improvement Model of Care to ensure that FHN’s Team-Based Care is the most sustainable, efficient method for providing high-quality, satisfying, and equitable health care to our patient population.

Job Type: Full-time

Pay: $18.50 - $22.00 per hour

Expected hours: 40 per week

Benefits: