Healthcare Coordinator Specialist

5 days ago

Baltimore, Maryland, United States LifeBridge Health Full time

About Us

LifeBridge Health is one of the largest healthcare providers in Maryland, serving over 1 million patients annually.

We strive to CARE BRAVELY and are committed to delivering high-quality care to our patients.

Job Summary

The Community Care Coordinator plays a crucial role in promoting the health and welfare of assigned patients through face-to-face and phone outreach, as well as email communications.

This position is part of the Interdisciplinary Team (IDT) caring for patients, ensuring their individual needs are identified and addressed in a timely manner.

The coordinator acts as a patient advocate, addressing primary physical and social needs, including assessing and linking community resources available to the patient.

Responsibilities

  • Contact patients, caregivers, and families to ensure preventive services are received by assigned patients.
  • Decrease identified care gaps by working with primary care offices to obtain timely appointments for assigned patients, including post-hospital discharge and annual wellness visits where appropriate.
  • Understand and apply principles of population health management to identify patients with uncontrolled chronic conditions and/or rising risk indicators and refer to Community Care Manager accordingly.
  • Provide care coordination services for patients requiring chronic care management.
  • Evaluate and refer patients to Community Care Manager when acuity changes.
  • Follow treatment plans written by providers and/or Community Care Manager.
  • Assess patient safety needs in their home environment and assist the IDT to evaluate the patient's needs in their home to facilitate self-management skills.
  • Lead IDT discussions in home management of assigned patients, including facilitation of home care referrals when necessary.
  • Facilitate discussion with patients and family members on advance directives.
  • Link patients with community resources, such as prescription assistance.
  • Assist patients in navigating social and health services, including enrollment in Social Security, Medicaid, Medicare, and other insurance plans.
  • Assess and assist patients' safety needs in their homes, i.e., fall risk and order equipment as necessary to promote independence.
  • Help patients manage their medication, i.e., setting up medication boxes if needed.
  • Refer patients or families to community resources for housing or treatment to aid recovery from chronic illness and follow through to ensure service efficacy.
  • Educate and support family members in understanding, dealing with, and supporting patients with chronic illnesses and end-of-life practices.
  • Conduct interviews about activities of daily living to determine needs and link with community resources when necessary.
  • Review and update provider and Community Care Manager on patients' living conditions and ability to adhere to the plan of care and coordinate treatment goals.
  • Monitor and evaluate patients' progress in their homes regarding treatment goals.
  • Document findings in healthcare records following approved protocols.
  • Collect data, maintain records, develop, and utilize assessment and measuring tools relative to patient care and wellness practices.
  • Obtain and coordinate access to primary care providers and other specialty providers, ensuring necessary records and documentation of referrals are completed and reconciled.
  • Educate patients on available resources for primary care and acute care, as well as alternative community programs and services that promote sound health, lifestyle, and well-being.
  • Schedule timely and appropriate office and follow-up visits at or with healthcare providers, such as dentists, public health, social services, or other outreach workers needed to provide comprehensive and quality care for patients.
  • Work independently with minimal supervision.
  • Perform community outreach activities as assigned.

Requirements

  • Licensed Practice Nurse or Certified Medical Assistant or trained Patient Care Assistant with 2-3 years of acute care and/or ambulatory practice experience.
  • Preferably with experience working with care managers from acute care settings or health insurance and/or other payer entities.
  • Good verbal and communication skills and organizational skills are essential.
  • Competency in electronic medical records is desirable.
  • Bilingualism is preferable (market-specific).

Salary: $17-$26 per hour based on experience.

About LifeBridge Health

As one of the largest healthcare providers in Maryland, we are dedicated to delivering high-quality care to our patients.

We have 13,000 team members across our network, serving over 1 million patients annually.

How to Apply

If you are passionate about making a difference in the lives of others, join our team today

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