Clinical Outreach Coordinator

3 weeks ago

Watkinsville, Georgia, United States CAAP Full time
Job Description

The Clinical Outreach Coordinator plays a pivotal role in ensuring seamless care coordination for patients with unmanaged chronic illnesses or high hospital utilization. As a liaison between patients, families, and healthcare teams, this role fosters continuity of care and promotes patient accountability for their health and wellness.

Key Responsibilities:

  • Develop and manage active care management lists, tailoring frequency and communication methods to individual patient needs.
  • Conduct thorough patient assessments to identify medical status, barriers, and concerns related to chronic illnesses.
  • Collaborate with patients, families, and healthcare teams to create comprehensive care plans addressing patient needs.
  • Integrate evidence-based practices into care plans and patient education, as appropriate.
  • Evaluate care plans to ensure patients are on track to achieve goals, adjusting plans as necessary.
  • Report patient concerns to the Clinical Programs Director for guidance on resolution.
  • Document all care management activities in the designated CIN documentation tool.
  • Participate in bi-weekly Complex Patient Care Presentation meetings.

Requirements:

  • Current MA/EMT/Paramedic certification.
  • Minimum three years of clinical experience, including care of patients with chronic disease states.
  • Strong interpersonal skills, including ability to form collegial relationships with diverse backgrounds.
  • Strong organizational, critical thinking, and problem-solving skills.
  • Strong verbal and written communication skills.
  • Ability to work independently and as part of a team with minimal supervision.
  • Competent in basic Microsoft Office skills.
  • Valid driver's license.
  • Previous Case Management experience preferred.

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