Clinical Outreach Coordinator- MA/EMT/Paramedic/LPN

1 day ago


Watkinsville, United States CAAP Full time
Job DescriptionJob Description

The Clinical Outreach Coordinator is responsible for facilitating and coordinating care for patients across the age span deemed as having an unmanaged chronic illness or chronic utilization of hospital resources by CIN staff, payors and/or providers. The Clinical Outreach Coordinator acts as a liaison between the patient, family and healthcare team; working to assure continuity of care when patients have experienced or at risk of experiencing inpatient services. The Clinical Outreach Coordinator encourages patients to be accountable for their own healthcare; coaching them in activities that promote health and wellness. The Clinical Outreach Coordinator is also responsible for assisting in the management of larger patient populations; participating in performance improvement (PI) activities with the goal of improving quality and reducing costs for these populations. The Clinical Outreach Coordinator primarily works Monday-Friday standard business hours, but this may vary based on the needs of the organization. The role requires occasional travel.

TASKS AND RESPONSIBILITIES:

Care Management

  • Develops an active Care Management list; managing the frequency of each patient’s care management sessions and whether these be performed via telephone or accompanying the patient to a provider office visit.
  • Performs an initial patient assessment to determine patient’s current medical status, identify barriers and concerns attributed to chronic illnesses.
  • Collaborates with patient, family and members of the healthcare team to develop a comprehensive plan of care that addresses the patient’s needs.
  • Integrates evidence-based practice into care plans and patient education as appropriate.
  • Effectively evaluates the plan of care to determine if the patient is on target for achieving goals. Adjusts plan accordingly as new information becomes available.
  • Reports any patient concerns to the Clinical Programs Director for assistance in determining how best to address and resolve these issues.
  • Documents all care management activities in the appropriate CIN documentation tool.
  • Participates in bi-weekly Complex Patient Care Presentation meetings.

QUALIFICATIONS:

  • Current MA/EMT/Paramedic Certification.
  • Minimum of three years of clinical experience, including care of patients with chronic disease states.
  • Strong interpersonal skills including ability to form collegial relationships with those from diverse backgrounds.
  • Strong organizational, critical thinking and problem-solving skills.
  • Strong verbal and written communication skills.
  • Strong work ethic including ability to manage multiple demands, meet deadlines and work at a rapid pace.
  • Ability to work both 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.


  • Watkinsville, Georgia, United States CAAP Full time

    Job SummaryWe are seeking a highly skilled Clinical Outreach Liaison to join our team at CAAP. This role will involve facilitating care for patients with unmanaged chronic illnesses, acting as a liaison between patients, families, and healthcare teams.Key Responsibilities:Developing active care management lists to manage patient sessions and provider office...


  • Watkinsville, Georgia, United States CAAP Full time

    **Job Title:** Clinical Outreach Professional**Job Summary:** We are seeking a highly skilled and motivated Clinical Outreach Professional to join our team at CAAP. As a key member of our care management team, you will be responsible for facilitating and coordinating care for patients with complex medical needs.**Responsibilities:**Develop and implement...


  • Watkinsville, Georgia, United States CAAP Full time

    **Job Description:** Healthcare Liaison CoordinatorWe are seeking a detail-oriented and organized Healthcare Liaison Coordinator to join our team at CAAP. The ideal candidate will have strong communication and interpersonal skills, as well as experience working in a fast-paced healthcare environment.**Key Responsibilities:**Coordinate care between patients,...


  • Watkinsville, Georgia, United States CAAP Full time

    CAAP is committed to providing exceptional patient care and outcomes, and we are seeking a skilled Clinical Outreach Coordinator to join our team.About the Job:This is a critical role that requires strong clinical expertise, effective communication skills, and the ability to work with patients, families, and healthcare teams to manage chronic illnesses.Key...


  • Watkinsville, Georgia, United States CAAP Full time

    Career OpportunityAs a Chronic Care Coordinator at CAAP, you will be responsible for coordinating care for patients with unmanaged chronic illnesses.Main Responsibilities:Developing and implementing care plans that address patient needs.Collaborating with healthcare teams to improve patient outcomes.Communicating with patients and their families to ensure...


  • Watkinsville, Georgia, United States CAAP Full time

    About the RoleCare Management Specialists play a vital role in improving patient outcomes by coordinating care for individuals with complex health needs.Responsibilities:Coordinating care for patients across the age span with unmanaged chronic illnesses.Acting as a liaison between patients, families, and healthcare teams.Developing and implementing care...


  • Watkinsville, Georgia, United States CAAP Full time

    **Job Overview:** Care Management SpecialistWe are seeking a highly skilled and compassionate Care Management Specialist to join our team at CAAP. As a key member of our care management team, you will be responsible for assessing patient needs and developing individualized care plans to promote optimal health outcomes.**Key Responsibilities:**Conduct initial...


  • Watkinsville, United States Trinity Health At Home Full time

    Job DescriptionEmployment TypeFull timeShiftDay ShiftDescriptionUnder the supervision of the Nurse Leader, coordinates home health careservices, labs; and any other equipment, supplies, external services for the agency clients as prescribed by thephysician, and/or requested by the client/family, and in compliance with the state’s Nursing Practice Act,...


  • Watkinsville, United States Trinity Health At Home Full time

    Job DescriptionEmployment TypeFull timeShiftDay ShiftDescriptionUnder the supervision of the Nurse Leader, coordinates home health careservices, labs; and any other equipment, supplies, external services for the agency clients as prescribed by thephysician, and/or requested by the client/family, and in compliance with the state’s Nursing Practice Act,...


  • Watkinsville, United States Trinity Health At Home Full time

    Job DescriptionEmployment TypeFull timeShiftDay ShiftDescriptionPOSITION PURPOSEResponsible for: the efficient and effective facilitation of referrals to the post-acute homecare/hospice agency once identified in the acute care setting; the provision of education to acute care staff, including physicians, regarding services available from homecare/hospice;...


  • Watkinsville, United States Trinity Health At Home Full time

    Job DescriptionEmployment TypeFull timeShiftDay ShiftDescriptionPOSITION PURPOSEResponsible for: the efficient and effective facilitation of referrals to the post-acute homecare/hospice agency once identified in the acute care setting; the provision of education to acute care staff, including physicians, regarding services available from homecare/hospice;...


  • Watkinsville, United States Trinity Health At Home Full time

    Job DescriptionEmployment TypeFull timeShiftDay ShiftDescriptionPOSITION PURPOSEResponsible for: the efficient and effective facilitation of referrals to the post-acute homecare/hospice agency once identified in the acute care setting; the provision of education to acute care staff, including physicians, regarding services available from homecare/hospice;...


  • Watkinsville, United States Trinity Health Full time

    Job DescriptionEmployment TypeFull timeShiftDay ShiftDescriptionSt. Mary's Home Care & Hospice in Watkinsville is seeking a full time Clinical Home Care Coordinator-must be an experienced licensed RN.Basic Job Function Summary Responsible for: the efficient and effective facilitation of referrals to the post-acute homecare/hospice agency once identified...


  • Watkinsville, United States Trinity Health At Home Full time

    Job DescriptionEmployment TypeFull timeShiftDay ShiftDescriptionSt. Mary's Home Care & Hospice in Watkinsville is seeking a full time Clinical Home Care Coordinator-must be an experienced licensed RN.Basic Job Function Summary Responsible for: the efficient and effective facilitation of referrals to the post-acute homecare/hospice agency once identified in...

  • Home Care Coordinator

    3 weeks ago


    Watkinsville, Georgia, United States Trinity Health At Home Full time

    Company Overview: Trinity Health at Home is a comprehensive home care provider dedicated to delivering exceptional, patient-centered care. Our pioneering care model, Home Care Connect, leverages advanced technology and clinical expertise to empower patients to achieve their health goals.Salary: $65,000 - $80,000 per annum, depending on experience and...

  • LPN - Orthopedics

    18 hours ago


    Watkinsville, United States Piedmont Athens Regional Specialty Services Full time

    Description:RESPONSIBLE FOR:The Licensed Practical Nurse provides nursing care under the supervision of a Registered Nurse or provider to patients form birth through the lifecycle utilizing the nursing process in accordance with Piedmont Healthcares Mission and Vision Statements; functions within the framework of their license and the policy and procedures...

  • LPN - Orthopedics

    15 hours ago


    Watkinsville, United States Piedmont Athens Regional Specialty Services Full time

    Description:RESPONSIBLE FOR:The Licensed Practical Nurse provides nursing care under the supervision of a Registered Nurse or provider to patients form birth through the lifecycle utilizing the nursing process in accordance with Piedmont Healthcares Mission and Vision Statements; functions within the framework of their license and the policy and procedures...

  • Hospice LPN Contingent

    7 months ago


    Watkinsville, United States Trinity Health Corporation Full time

    Employment Type: Part time Shift: Description: St. Mary's Home Care & Hospice is seeking a Contingent Hospice LPN for the Athens area Provide one-to-one, compassionate care, and love your job St. Mary's Home Care and Hospice located in Athens, GA provides compassionate, exceptional care where people are most comfortable: at home. We are the area's most...

  • Home Care LPN

    2 months ago


    Watkinsville, United States Trinity Health Corporation Full time

    Employment Type: Full time Shift: Description: St. Mary's Home Care & Hospice is seeking a Full Time LPN for Homecare revisits. Offering $5,000 sign on bonus - Flexible Scheduling Opportunities - Day 1 benefits * Signing Bonus is not applicable to internal employees, former employees who have resigned in the last year or applicants sourced from outside...

  • Hospice LPN Contingent

    7 months ago


    Watkinsville, United States Trinity Health Full time

    **Employment Type:** Part time **Shift:** **Description:** **St. Mary's Home Care & Hospice is seeking a Contingent Hospice LPN for the Athens area** Provide one-to-one, compassionate care, and love your job St. Mary's Home Care and Hospice located in Athens, GA provides compassionate, exceptional care where people are most comfortable: at home. We are...