Care Coordinator - Population Health

Full Time
San Bernardino, CA 92410
Posted
Job description

About SAC Health:


SAC Health’s mission is to reflect the healing ministry & love of Jesus Christ through healthcare, education & partnerships that empower our communities to flourish


SAC Health’s Core Values:


Quality Healthcare
– providing patient-centered, culturally-sensitive, equitable care that is safe, timely, effective, efficient, while seeking to prevent illness & disability
Teamwork – working together to achieve a common goal, with a willingness to serve each other in a Christ-like manner
Wholeness – ministering to the spiritual, physical, mental & emotional needs of others
Integrity – living & working in an authentic, honest way that inspires trust
Compassion – engaging with the needs & suffering of others, out of concern for their wellbeing
Excellence – striving to exceed expectations for our patients, community, & staff
Humble Service – caring with a kind & selfless spirit
Respect – holding others in high regard by empowering them to reach their God-given potential


DESCRIPTION:


As a member of the Quality Team, the Care Coordinator assists in screening initiatives. Utilizes EMR generated reports to identify and actively engage in patient outreach. Identifies eligible patients and care coordination of screening results to ensure appropriate follow up. Responsible for accurate and timely tracking of productivity statistics, program status, challenges, updates and developments. Works under the supervision of the Manager of Compliance and Quality. Job requires adaptability and ability to work under pressure and meet deadlines; ability to work as a team and contribute to the development of an effective work environment; exceptional communication, organizational and office and interpersonal skills. Performs other duties as needed.


Hours:
Monday - Friday, 7:30 am -4:00 pm OR 8:00 am 4:30

Location : Hospitality Lane, San Bernardino


ESSENTIAL FUNCTIONS AND DELIVERABLES:


  • Performs daily screenings using EMR generated appointment reports to identify those eligible for CQM (Clinical Quality Measures) services.
  • Alerts provider of need to place order for appropriate CQM services.
  • Performs care coordination to ensure completion of CQM-related provider orders.
  • Schedules appointments in EPM and works with staff when necessary to fit patient into physician schedule.
  • Contacts patients in between visits to determine if services were provided or if support is required prior to next appointment.
  • Ensures that results are received timely and entered into the electronic medical record (EMR).
  • Actively monitors results to ensure appropriate follow up and diagnostic studies are ordered and completed, as appropriate.
  • Uses established care guidelines to implement provider-directed reminders and recalls in the EMR.
  • Utilizes EMR generated appointment reports to capture missed appointments.
  • Performs abstractions of screening results into EMR system, as needed.
  • Will maintain ongoing management of patient panels, review and update panel assignments regularly.
  • Ensures all SACHS patients are empaneled to a primary provider and/or care team.
  • Use panel data to contact, educate, and track patients by disease status, risk status, self-management status, community and family need
  • Resolve unassigned patients by reviewing appointment history to determine the appropriate PCP assignment using the Four-Cut Methodology process.
  • Serves as a liaison and resource to clinic staff and patients.
  • Maintains accurate and up-to-date tracking system for CQM management.
  • Monitors and reports productivity statistics, program status, challenges, updates and developments to Quality Team on a weekly basis. Uses reporting tools and data to inform work practices and provide feedback to end users.
  • It is the expectation of SACHS that all staff members exhibit critical thinking and problem solving skills even if it means going above and beyond your job description to find a solution.
  • Other duties as assigned by Manager/Director.


Qualifications:


  • Education: High School Diploma or equivalent required.
  • Medical Assistant Diploma or Certificate required.
  • Experience: Minimum of 1 year of medical assisting, customer service, general office, or receptionist vocational training experience required. Medical knowledge required. Database and electronic health record experience preferred. As a requirement of this position you must receive EPIC certification for the module you have been hired into.


PREFERRED:


  • FQHC outpatient clinic
  • Bilingual English/Spanish


Must be legally authorized to work in the United States on a full-time basis. Must not now or in the future require sponsorship for employment visas.


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Full Benefits Package:

  • PTO and Sick Leave Plans
  • Medical / Dental / Vision package
  • Monthly Health Insurance Premium Rates among the lowest in the industry
  • Retirement Account with up to 8% employer contribution
  • Employer-paid Life Insurance
  • Fitness Facility access
  • 8 Paid Holidays
  • 1 Paid Birthday Holiday


EEO

SAC Health complies with applicable Federal and State civil rights laws and does not discriminate based on race, color, national origin, age, disability, sex, sexual orientation or gender identity.

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