Summary of Position:
The Care Coordinator is a trained professional that enrolls patients into the Chronic Care Management Program to manage their chronic conditions. Enrollments will include determining patient eligibility for CCM program, obtaining and documenting patient’s verbal consent into the CCM program, explaining the CCM program to the patient, creating care plan for provider signature, assessing current health status, educating patients about their chronic conditions, answering questions and acting as a resource between the patient and the provider, addressing any urgent patient needs, and following up on any changes in patient condition.
Job Duties & Responsibilities Include but are Not Limited to:
CCM verbal enrollments.
Communicate with patients and family members about their chronic conditions, medications, quality measures, barriers to care, and practice specific requests.
Communicate effectively with providers, staff, and other healthcare professionals.
Promote adherence to a care plan, developed in coordination with the patient, primary care provider, and family/caregiver(s).
Increase patients’ ability for self-management, shared decision-making, and assist patients in reaching established goals.
Medication reconciliation.
Connect patients to relevant community resources, with the goal of enhancing patient health and well-being, increasing patient satisfaction, and reducing healthcare costs
Represent CCS in a caring and professional manner to providers and other healthcare professionals.
Comply with organizational guidelines and healthcare laws and regulations, including CMS guidelines.
Be flexible and a team player.
Maintain expected call volume (see Call Expectations Policy).
Required Skills and Qualifications:
Unencumbered active CMA/RMA certificate or unencumbered active compact license LPN/RN.
Active BLS certification
Ability to plan and organize time effectively, work independently and show good judgment.
Excellent problem solving, clinical reasoning, and critical thinking skills.
Ability to communicate effectively both verbally and in writing.
Knowledge of CCM regulations and of CCM billing requirements.
High proficiency in working within EHR systems.
Operational knowledge of Google Suite, Atlas, and other required software.
Home Office:
Care Coordinators must have a HIPAA compliant workplace that is free of any distractions. The workplace must be in a room with a locked door to prevent accidental PHI disclosures. The home office must have high-speed internet and a CCS approved computer with two monitors.
Physical Demand:
Includes but is not limited to vision, hearing, repetitive motion, typing, sedentary, and extended viewing of a work environment computer screen. Reasonable accommodation may be made, with advanced notice, to enable individuals with disabilities to perform the essential functions and expectations of the position without compromising patient care.
By signing below I accept and agree to the outlined terms as stated above. I hereby acknowledge that I have received, reviewed, and understand the Care Coordinator Job Description.
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