Ambulatory Care Specialist
2 days ago
Ambulatory Care Specialist is a pivotal role at Springfield Medical Care Systems, Inc. where you will engage individuals seeking to prevent and manage chronic conditions. You will identify their priorities for care, develop a care plan, and coordinate its implementation in partnership with the patient, their care team, and community partners.
About Us
Springfield Medical Care Systems, Inc., an independent Federally Qualified Health Center, is comprised of multiple PCMH practices delivering team-based care in Southern VT and Southwestern New Hampshire. We are seeking an Ambulatory Care Specialist to join our team based at our Springfield Health Center.
Responsibilities
- Assess patients' clinical, social, functional, and continuing care needs to identify priorities and desired outcomes for treatment
- Develop a care plan including immediate, short-term, and long-term goals reflecting patients' priorities and timeframes to achieve desired outcomes
- Demonstrate knowledge and understanding of clients' diagnoses, prognoses, care needs, as well as costs and barriers to goal achievement
- Assist in transition of care through patient outreach, communication with relevant service providers following discharge from other care settings to ensure a smooth transition to outpatient care, with the goal of decreasing readmissions
- Coordinate with other team members to provide exceptional patient service
Requirements
- Two (2) years of nursing experience
- Proficiency with Microsoft Office, computer skills
- Experience with care planning
- Proactively outreaches to selected patients, performs home visits as necessary for assessment and engagement
Estimated Salary: $65,000 - $75,000 per year
Benefits
All new hires are required to show proof of COVID vaccination or request an exemption prior to starting work.
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