Hybrid Care Coordinator (Bilingual in English & Spanish preferred bei SOUTHWEST UTAH COMMUNITY HEALTH CENTER

Description

Summary of Duties:

• Assists patients through the healthcare system by acting as a patient advocate and navigator.
• Participates in Patient-Centered Medical Home team meetings and quality improvement initiatives.
• Facilitates health and disease patient education which may include leading group office visits.
• Supports patient self-management of disease and behavior modification interventions.
• Coordinates continuity of patient care with external healthcare organizations and facilities, including the process hospital admission and discharge and referrals from the primary care provider to a specialty care provider.
• Coordinates continuity of patient care with patients and families following hospital admission, discharge, and ER visits.
• Manages patents considered high risk for poor health outcomes, including management of patients with multiple co-morbidities or high risk for readmission to a hospital setting, including a registry.
• Coordinates comprehensive, preventive screenings for patients and/or assists all support staff in daily patient interactions and office encounters as needed.
• Promotes clear communication amongst a care team and treating providers by ensuring awareness regarding patient care plans.
• Facilitates patient medication management based upon standing orders and protocols.
• Participates on the Quality Management Committee for data collection, health outcomes reporting, clinical audits, and programmatic evaluation related to the Patient-Centered Medical Home and Medical Neighborhood initiatives.

         Assists in the evaluation of clinical care, utilization of resources, and development of new clinical tools, forms, and procedures.

Requirements

Education and Experience:

• Proficient computer skills, including Microsoft Office (specifically Word and Excel)
• 2-5 years experience in a clinical setting
• Self-disciplined, energetic, passionate, innovative
• A team player that can follow a system and protocol to achieve a common goal
• Highly organized and well-developed oral and written communication skills
• Demonstrates sound judgment, decision-making and problem-solving skills
• Able to maintain confidentiality with all aspects of information in accordance with practice, State and Federal regulations
• Confidence to communicate and outreach to other community health care organizations and personnel
• 1 year in a Patient-Centered Medical Home clinical setting or knowledge of the Patient-Centered Medical Home initiative
• 2-5 years experience in chronic disease management, case management, utilization management, and adult acute care
• Experience with public speaking
• Experience with electronic medical records

         Optional: 

         Other licensed medical professionals who possess the appropriate clinical skills are also eligible.