||Patient Centered Medical
||Clinical Care Coordinator
||The Clinical Care Coordinator will serve as an adjunct to the patient’s primary care provider to coordinate their maintenance healthcare needs designed to optimize health for a variety of chronic disease conditions such as diabetes, hypertension, hyperlipidemia,
and others. The Clinical Care Coordinator will initiate care for assigned patients under protocol and supervision of a physician that will include the scheduling of office visits, diagnostic tests, and ordering of prescription refills, as necessary to meet
the criteria set forth for the management of their particular chronic condition.
• Establish close relationships with patients that will increase compliance with treatment recommendations
• Be a valued member of the team that will oversee the management of patients and the PCMH program as a whole
• Review and facilitate care plans under provider’s guidance or documented protocols for patients to include coordination of care; which includes the scheduling of patient for services necessary to meet disease management guidelines, and follow-up as needed.
• Coordinate transitions between various areas of care
• Develop nursing care plans that correlate with the physician’s care plan that include Clinical Care Coordinator outreach, education, goal setting, and overall patient compliance.
• Update patient medical records to reflect current condition, medications, etc… and remove outdated or lapsed conditions/medications
• Ensure an appropriate documentation and reporting system for patient results/concerns and provides recommendations for resolution or change as needed
• Review reports generated both internally by PCMH and by insurance payers for quality improvement and appropriate care opportunities
• Meets and actively participates with cross-functional teams to review PCMH metrics and discuss quality improvements.
The above statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not intended to be construed as an exhaustive list of all responsibilities, duties and skills required of
personnel so classified.
• Minimum High School diploma or equivalent required
• LPN licensed by the state in which employed or Registered/Certified Medical Assistant
• Ability to work independently with strict adherence to protocols in an accountable manner
• Empathetic and patient
• Excellent communication skills both written and oral
• Superb time-management, organizational and problem-solving skills
• Customer Focus
• Ethics and Values
• Interpersonal Savvy
• EMR and scheduling proficiency
• Basic knowledge of Microsoft Office
• Problem Solving
Combination of walking, sitting, standing, bending, reaching, and lifting. Must be able to lift up to 10 pounds. Specific vision abilities required by this job include close vision, distance vision, color vision, peripheral vision, depth perception, and ability
to adjust focus. Occasional stress from balancing multiple tasks.
- We are an Equal Opportunity Employer.
- All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, or national origin. We are also an equal opportunity employer of individuals with disabilities and protected veterans. Please view Equal Employment
Opportunity Posters provided by OFCCP
- Holston Medical Group participates in E-Verify
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