Patient Care Coordinator

1 week ago


Bridgeport, Michigan, United States Great Lakes Bay Health Centers Full time

At Great Lakes Bay Health Centers, we are seeking a skilled Patient Care Coordinator to join our team as a Population Health Specialist. This role is an exciting opportunity for a motivated and compassionate individual to make a meaningful difference in the lives of our patients.

About the Role

We are looking for a dedicated professional who can facilitate and guide patients through ongoing clinical and self-management support, resulting in improved access, improved clinical outcomes, or decreased cost of care. The successful candidate will be responsible for identifying patients with a high risk score, engaging them in the care management program, and developing individualized care plans.

The Population Health Specialist will work closely with other members of the care team to ensure safe, timely, efficient, and effective transitions of care for patients. This includes collaborating with Community Health Workers, Integrated Behavioral Health professionals, and other relevant care teams to provide comprehensive care management.

Key Responsibilities
  • Identify populations of focus through risk stratification or provider referral, utilizing data on diseases diagnosis, social determinants of health, ER and hospital admissions, and behavioral health conditions and indicators.
  • Develop and implement individualized care plans that address the unique needs and goals of each patient.
  • Patient outreach and enrollment in the care management program, ensuring that all eligible patients receive the support they need.
  • Collaborate with healthcare providers to develop and update care plans, providing ongoing communication and education to patients and their families.
  • Foster a positive patient-centered experience by considering safety, maintaining accurate records, and adhering to policies and procedures.
Requirements

To be successful in this role, you will need:

  • A strong understanding of population health principles and practices.
  • Excellent communication and interpersonal skills, with the ability to work effectively with patients, families, and healthcare providers.
  • Ability to analyze data and identify trends, with a focus on improving health outcomes and reducing costs.
  • Strong organizational and time management skills, with the ability to prioritize tasks and manage multiple projects simultaneously.
  • Experience working in a healthcare setting, preferably in a population health or care management role.
About Our Company

Great Lakes Bay Health Centers is a leading provider of primary care services in the region, committed to delivering high-quality, patient-centered care. We offer a competitive salary range of $55,000-$75,000 per year, depending on experience, plus a comprehensive benefits package, including medical, dental, and vision insurance, paid time off, and opportunities for professional growth and development.



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