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Now Hiring: Care Coordinator

By Potomac Local News December 8, 2013 4:40 pm

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Position Description

Care Coordinator

Direct Report

Care Coordinator Supervisor

FLSA Status


Team Philosophy Statement

The Center provides affordable access to integrated and coordinated primary, dental, prenatal, and behavioral health care services to the entire family under one roof. We operate with a team of caring, competent, and productive providers and staff who focus on quality, compassionate, and coordinated care in order to provide outstanding service to patients and families. Our staff place a high value on teamwork. They must accept changing duties, be multi?skilled, and perform a variety of tasks in the care of our patients. Each member of the team is dedicated to continuous learning, and contributes toward our goal of providing outstanding health care services to our patients.

Position Description

The Care Coordinator provides coordinated care to target patient populations by developing, monitoring, and evaluating community and health care services. The position is mission-driven and responsible for outreach, intake and assessment, development of an individualized care plan, coordination and delivery of services (patient advocate), chart reviews, performance measure reporting, and transition of patients out of the program.

The Care Coordinator is a member of the Care Coordination Team and acts independently and in team-settings to provide assessment, monitoring, and the facilitation of integrated services that lead to superior patient care, effective communication, and collaboration among 50+ colleagues. This position will serve as the patient navigator working with community partners, parents and family members, colleagues, and vendors.

This position will also determine the source of financial resources necessary fro the patient to receive the care needed. Resource sources include grant funds, nominal patient fees, commercial insurance and Medicaid revenues. This position will be responsible for scheduling appointments, determining and, where eligible, enrolling and renewing the target population in commercial insurance plans and Medicaid.

This position will be responsible for data entry and reporting in eClinicalWorks, the Center’s electronic health record system. The position will be responsible for facilitating chart reviews for patients under their care, and monthly performance measures on their productivity and the no show rates and health outcomes of their patients. This position works with multiple other departments at the Center (finance, operations, quality, human resources and the four Center practices. This position will be responsible for their own budget, including revenues and expenses.

This person demonstrates independent judgment, integrity, and self-sufficiency in effective problem-solving while serving as a resource for the Center, community partners, and patients. This person has a Bachelors or Masters Degree with a minimum of five years of care coordination, patient navigation, case management, and/or social services in a private, public, or non-profit organization. The person possesses interpersonal, communication, and team player skills and excels in the constant change associated with a rapidly expanding and complex health care organization. The person exhibits mature behavior and judgment and always maintains a “can do” attitude.

The position has health care and/or clinical experience and skill sets, e.g., problem-solving, project management, budgeting, planning that will contribute to the success of a rapidly expanding Federally Qualified Health Center. This person has a functioning knowledge of the organization’s relationship to local, state, and Federal government agencies, other non-profit organizations, and the private sector. The person should clearly understand and be able to communicate with all community stakeholders and patients the role of the Center in the health care service continuum, including the resources and services available to the target population. Over time, the person develops a mastery of the Center’s technology systems, including electronic health records, computerized patient check-in, patient portal, Intranet, telephone system, etc.) Technology is viewed as an enabling resource and is used in driving greater staff productivity, employee morale, patient satisfaction, and patient health outcomes.

Essential Functions

1. Orients and educates new and established patients and their families by meeting them; explaining the role of the Care Coordinator, and the process and timeline for delivery of care in and outside of the Center.

2. Conducts on-going in-reach and outreach efforts to inform and educate new and established patients, coordinates efforts with other community partners. Supports the planning, development and implementation of an outreach/marketing program, including participation at health fairs, school events, special events, and the Patient Satisfaction Survey.

3. Develops a clinical needs assessment and individualized patient care plan, coordinates care requirements with Center providers and specialists, and identifies and resolves barriers that could affect the smooth delivery of care.

4. Maintains expertise in eligibility and enrollment in the health insurance marketplace and all Medicaid products and facilitates selection of insurance coverage and/or other means of funding the care needed by the patient.

5. Monitors delivery of care by documenting care; identifying progress toward desired care outcomes; intervening to overcome deviations in the expected plan of care; reviewing the care plan with patients in conjunction with the direct care providers; interacting with involved departments to negotiate and expedite scheduling and completion of tests, procedures, and consults; reporting personnel and performance issues to supervisors; maintaining on-going communication with utilization review staff regarding variances from the care and transition plans.

6. Evaluates outcomes of care with an interdisciplinary team by measuring intervention effectiveness with the team; implementing team recommendations. Complies with Center and legal requirements by fostering clinical practices that adhere to the Center’s philosophy, goals, and standards of care, e.g., delivery of care in the native language; requiring adherence to governing regulations.

7. Respects patients by recognizing their rights; maintaining strict confidentiality of personal health information (PHI). Maintains quality service by establishing and enforcing organization standards. Maintains patient care information in EClinicalWorks and other Center systems by entering new information as it becomes available; verifying findings and reports; and ensure data integrity.

8. Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; and benchmarking state-of-the-art practices. This position will be responsible for monthly performance reports to the Executive Director and the Board of Directors.

9. Performs other duties and responsibilities as assigned by the Executive Director.

Qualifications, Education, and Experience

1. Bachelor or Masters Degrees in a relevant field (see above). An advanced degree in public health is preferred.

2. Five years or more of directly-related experience in case management, patient navigation, care coordination at a public, private, or non-profit health or human service organization. Operational experience at an FQHC is highly desirable.

3. Must speak, write, and read Spanish.

Greater Prince William Community Health Center

4379 Ridgewood Center Drive, Suite 102, Woodbridge, VA 22192