Care Coordinator

At Virginia Garcia Memorial Health Center, we welcome diversity; we encourage, uplift, and are honored to serve people who have been historically underrepresented and underserved. Our mission is to provide high-quality, culturally appropriate healthcare to low-income residents of Washington and Yamhill Counties, with a special emphasis on seasonal and migrant farm workers and others with barriers to receiving healthcare. We strive to provide an inclusive environment that welcomes and values the diversity of the people we employ and serve.

If you are unsure whether you meet all the required qualifications for this role but are interested and passionate about this potential position, we encourage you to apply.

Starting Rate: $25.8399/hr + DOE

Schedule: Monday-Friday 8:00am-5:00pm

Job Summary: The Care Coordinator - LATS Program works as part of a team to provide admission screening and intake, care planning, case management, patient education and health navigation, and clinical care within the scope of practice, for patients being discharged from the hospital setting without stable housing for recovery.

The CC-RC performs a wide range of duties, which may include assisting in providing patient care, supporting an RN or clinical provider, receptionist/intake duties, supporting referrals, and miscellaneous administrative duties. This position will be based at the VG 7th Ave Clinic, will require travel to the RCP program site in Hillsboro, and may require travel to local hospitals for discharge planning.

Essential Duties and Responsibilities:

Huddle daily with RCP team to create and implement action plans to perform transition of care visits for patients being discharged from hospitals, follow up with outside provider recommendations after outpatient visits and ensure that treatment recommendations and medication changes are acknowledged and actualized.

Assist with coordination of patient referral from inpatient hospital stays, coordinate hospital follow-up visits, and work with RN to act as a liaison between patients and outside agencies.

Register and update patient information in EHR, including REALD and Annual Verification Forms while assisting RN with intake to RCP.

Document medical information in patients electronic health records.

Collect proper documentation of patient financial and insurance status, including patient access to OHP enrollment through shelter partner or VG, as appropriate.

Coordinate care and facilitate connections to appropriate providers (e.g., PCP, home health, pharmacies, specialty care) ensuring health information is transferred to providers.

Provide support for referrals (schedule appointments as necessary, track, provide records and obtain reports).

Facilitate patient access to obtain durable medical equipment (DME), wound care, oxygen, and incontinence supplies (as needed).

Use the Collective Medical Platform to ensure real-time coordination of care between VG and hospital settings.

Coordinate with shelter case management to address SDOH and other non-clinical needs.

Share pertinent health information with additional providers (as indicated), and with the patient and their community-based provider at program discharge, including medication list, PCP and specialty provider contacts, and case management and community resources.

Educate patients on how to utilize after-hours number or daytime nurse triage to address immediate clinical needs.

Support language access using an interpretation service as needed.

Assist with scheduling outside transportation services.

Provide culturally and clinically appropriate patient education and information to patients in accordance with training and experience.

Travel to clinics, hospitals, agencies, etc. as needed.

Handle protected health information in a manner consistent with the Health Insurance Portability and Accountability Act of 1996 (HIPAA)

Perform other duties as assigned.

HIPAA Requirements:

The CCRC will access patients medical records in the course of performing this job. Applying the minimum necessary standard of HIPAA, the designated record sets to which this employee will have access include: all sections of the medical record including patient demographic information in the practice management system. The CC-RC is required to read the content of these records only to the extent needed to accomplish the assigned task (e.g., filing or disclosure).

Knowledge, Skills and Abilities Required:

Verbal proficiency in English and Spanish preferred.

Demonstrated ability to work effectively in a team environment.

Demonstrated problem solving skills in a complex environment.

Ability to take initiative to proactively organize and manage the responsibilities of the job.

High degree of integrity and professionalism.

Demonstrated effective interpersonal relationship and customer service skills.

Good organizational and time management skills.

Good working knowledge of local social service resources or ability to acquire and use this knowledge and information expeditiously.

Desire to work with the Hispanic community and carry out the mission of the Center.

Ability to work effectively with people from diverse cultures and diverse socioeconomic situations.

Basic level of proficiency with Microsoft Office (Word, Excel, Outlook) and ability to use other computer programs and applications (Epic, Collective, LabLink etc.) in ways that facilitate care coordination.

Education and Experience:

One of the following is required:

o Associate degree in healthcare administration, Social Science, Social Work, or related, or

o Medical Assistant Certification, or

o Four years of experience in a healthcare or social service-related administrative role.

Two years prior experience working with underserved populations preferred.

Communication skills, spoken and written, equivalent to two years of college education.

Valid drivers license, reliable transportation, safe driving record and insurance coverage required.

Behavioral Competencies:

Accountability

Role model VGs mission, vision, and shared values

Customer-Focus

Listen to the voice of the customer and strive to delight them by exceeding their expectations.

Teamwork

If someone needs help, help them.

Initiative

Be innovative, apply fresh ideas, and continuously improve how you do your work.

Confidentiality

Maintain strict confidentiality and respect the privacy of others.

Ethical

Demonstrate integrity, honesty, and stewardship in all encounters at work.

Respect

Demonstrate consideration and appreciation for co-workers and patients.

Communication

Demonstrate the ability to convey thoughts and ideas as well as understand perspective of others.

Physical Requirements:

Standing: 35%

Walking: 15%

Sitting: up to 25%

Lifting/Carrying: 5% - up to 30 pounds on occasion

Travel: up to 20%

Working Environment/Physical Hazards:

Work in a well-lighted, ventilated environment.

Work in office, in clinic and outdoors, often exposed to variations in weather and conditions.

Potential exposure to blood borne pathogens and hazardous chemicals.

Equipment Used:

Computer, Telephone, Fax, Copier, Scanner, Printer

Immunization:

Staff members must meet immunization requirements as stated in VGMHCs immunization policy and state and federal guidelines.

Job classification represents a general outline of the essential and major job duties, functions and qualifications required. They cannot be all-inclusive and comprehensive due to the dynamic nature of work performed to accomplish VGMHCs Mission.

VGMHC is an Equal Opportunity Employer. No person is unlawfully excluded from consideration for employment because of race, color, religious creed, national origin, ancestry, sex, age, veteran status, marital status or physical challenges. The policy applies not only to recruitment and hiring practices, but also includes affirmative action in the area of placement, promotion, transfer, rate of pay and termination.