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Care Coordination Specialist
2 months ago
EMrecruits is seeking a dedicated Care Coordination Specialist with qualifications as an RMA, LPN, or RN. This role is pivotal in ensuring seamless transitions for patients moving from hospital settings to their ongoing care.
The Care Coordination Specialist is responsible for monitoring patients post-discharge and facilitating comprehensive care management. This includes medication reviews, chronic disease oversight, and patient education to enhance health outcomes.
Key Responsibilities
- Collaborate with Primary Care Providers (PCPs) and community resources to deliver a holistic approach to patient care, taking into account individual social and cultural factors.
- Serve as a key point of contact among PCPs, health departments, social services, hospitals, and community organizations to ensure coordinated care delivery.
- Engage with network providers to guarantee effective management of client health needs.
- Establish and nurture partnerships with community service organizations through outreach and educational initiatives.
- Support patients in navigating their healthcare concerns by facilitating referrals and communication with the healthcare team.
- Maintain accurate client records within the Electronic Health Record (EHR) system.
- Design and execute personalized care management strategies for designated patients.
- Conduct follow-up and outreach through various methods including home visits, phone calls, or mail correspondence.
- Inform patients and their families about the significance of managing their medical care and how to effectively access services within the healthcare system.
- Provide education on chronic conditions, focusing on medication adherence and preventive care.
- Ensure compliance with hospital discharge protocols for patients at high risk, ensuring continuity of care.
- Act as a resource for providers to promote the application of Evidence-Based Practices.
- Assist healthcare providers in coordinating services for patients with complex health needs by implementing Evidence-Based Practices.
- Organize and deliver health education programs and training sessions.
- Advocate for patients to access services that enhance their health and well-being.
- Review patient care plans to eliminate redundant or unnecessary services, optimizing cost efficiency.
- Conduct audits and gather data to support initiatives focused on disease management.
- Ensure patient and family confidentiality in accordance with HIPAA regulations.
- Perform additional responsibilities as needed.
Qualifications
- Degree in RMA or Nursing (RN or LPN) is required.
- Experience in direct patient care or managed care is highly desirable.
- A valid driver's license is necessary.
- Personal transportation is required for travel between locations.
- Familiarity with HEDIS Quality Measures is preferred.
- Strong communication and customer service skills are essential.
- Proficiency in Microsoft Word, Excel, and PowerPoint is required.
- Ability to work independently while collaborating effectively with team members.
- Self-motivated with strong prioritization skills and a commitment to improving operational efficiencies.
