Position Summary:

The Patient Care Coordinator provides ongoing support to patients with chronic medical conditions through proactive outreach, care coordination, patient education, and disease management. Candidates must demonstrate compassion, professionalism, empathy, and exceptional communication while building trusting relationships with patients and caregivers. Provide outstanding customer service by actively listening, maintaining a positive attitude, and promoting an exceptional patient experience. Working under the direction of the Chief Quality Officer and Value Based Practice Manager or Director, this role serves as a primary point of contact for enrolled patients while collaborating with providers and care teams to improve patient outcomes.

Essential Responsibilities:

• Conduct routine patient outreach to monitor health status, provide education on chronic disease management to ensure the patient understands their treatment plan and reinforce care plans.
• Recognize symptoms requiring intervention.
• Perform medication reconciliation during patient encounters, assess medication adherence, identify barriers or concerns, and communicate medication-related issues to providers while reinforcing prescribed treatment plans.
• Assist with patient enrollment into Chronic Care Management and Remote Patient Monitoring Programs.
• Maintain HIPAA compliance and patient confidentiality, ensure accurate and timely documentation, and comply with organizational policies and regulatory requirements.
• Support quality improvement initiatives and identify patients who may benefit from additional care management services.
• Coordinate communication among providers, specialists, hospitals, pharmacies, caregivers, home health agencies, and community resources while assisting patients in navigating the healthcare system.
• Ensure patients have follow-up care within White-Wilson, to assist in reducing gaps in treatment.

Required Knowledge, Skills & Abilities:

Possess knowledge of chronic disease management, preventive care, medication management, and patient education principles. Demonstrate strong communication, documentation, organizational, critical thinking, and time management skills while working independently and collaboratively within an interdisciplinary healthcare team. Experience providing telephonic patient support, knowledge of motivational interviewing techniques.

Minimum Qualifications:

• High school diploma or equivalent required.
• Current Medical Assistant certification or registration as required by state regulations.
• One year of experience in primary care, internal medicine, family medicine, care coordination, or chronic disease management is preferred.
• Experience with Electronic Health Records is required.
• Experience in Chronic Care Management, Care Coordination, Value-Based Care is preferred.

Performance Expectations:

Success in this role is measured by timely completion of patient outreach, accurate documentation, medication reconciliation, patient engagement, maintenance of individualized care plans, prompt escalation of clinical concerns, effective collaboration with the healthcare team, reduction in gaps in care, achievement of quality goals, and delivery of compassionate, patient-centered care.

PHYSICAL DEMANDS:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential job responsibilities.

While performing the duties of this job, the employee is occasionally required to stand; walk; sit for extended periods of time; use hands to finger, handle, or feel objects, tools, or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, bend, crouch or crawl; talk or hear; taste or smell. The employee must occasionally lift and/or move up to 40 pounds. Repetitive motion of upper body is required for extended use of computers and phones. Required specific vision abilities include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.

Position Type/Expected Hours of Work:

This is a full-time position in an outpatient medical business office setting, or can be remote. Days and hours of work are Monday through Friday between the hours of 8:00am to 5:00pm. Based on business need, the ability to work a flexible schedule, including some overtime as approved in advance.

WORK ENVIRONMENT:

The work environmental characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential job responsibilities.

Works in a well-lit, ventilated and climate-controlled office environment with routine office equipment; some equipment has moving mechanical parts. Noise level in the work environment is usually quiet to moderate.

Other Duties:

Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.

EEO Statement:

White-Wilson Medical Center, P.A. and affiliates are equal opportunity employers, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability status, protected veteran status, or any other characteristic protected by law.