Patient Centered Medical Home Care Coordinator

4 weeks ago


Cleveland, Ohio, United States Northeast Ohio Neighborhood Full time
Job DescriptionJob Description
The Patient Centered Medical Home (PCMH) Care Coordinator will facilitate care coordination services for NEON patients who need wellness and preventive care. The PCMH Care Coordinator will assist with the management of the computerized data repository, including generating population health data reports and patient profiles, utilizing data for population health management, and addressing gaps in service and care. Works closely with care teams to maximize patient follow through with care plans. As a collaborating member of the health care team, provides pre-visit and follow-up direction and support to the patient, family, and health care providers. Participates in PCMH and quality improvement initiatives. Empowers patient self-management of their care and promotes Patient Centered Medical Home Model of Care.
Key Responsibilities:
Facilitate care coordination services for NEON patients
Manage computerized data repository
Generate population health data reports and patient profiles
Utilize data for population health management
Address gaps in service and care
Work closely with care teams
Provide pre-visit and follow-up direction and support
Participate in PCMH and quality improvement initiatives
Empower patient self-management of their care
Education:
High School Diploma or GED is required
Bachelor's degree in Health or Social Sciences, Business, Health Care Administration, Public Health or Health Education is preferred, or related work experience
Minimum Qualifications:
Excellent verbal and written communication skills as well as good listening skills
Knowledge of health disparities and chronic disease management treatment resources
Strong organizational skills, attention to detail and timely documentation required
Proven critical thinking and problem solving skills
Knowledge of Ohio Medicaid Managed Plans
1-2 years at a hospital, outpatient clinic or insurance plan, preferably including navigating specialty referral process
Technical Skills:
Demonstrated knowledge and proficient in the use of Microsoft Office and Outlook
Ability to become proficient in the use of NextGen software

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