Population Health Clinical Care Coordinator (FT)--Remote (Connecticut Based Only)

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Job Description Summary:

Job Description:

**Monday- Friday, start time 7:30 or 8am. Occasional travel to CHC Inc clinics, must be flexible with travel. Remote position, Connecticut based only**

• Provides clinical, administrative and technical support for the Population Health Department to ensure successful achievement of all value based and other program specific metrics. This includes direct contact with CHC’s patients to facilitate appointment scheduling, data collection, and closing of care gaps among other services.
• The Population Health Clinical Care Coordinator (PHCCC) is essential to the Population Health Department. The PHCCC enhances the clinical care delivery of the Population Health team by delivering care to the top of their training and education. This role facilitates processes and delivers support that ensure that the team’s Population Health Registered Nurses (PHRN) are able to complete required patient care delivery of the highest quality and at the top of their license, while also meeting the operational and financial goals of the organization.

ROLE AND RESPONSIBILITIES

Population Health (PH) Clinical Care Coordinator (CCC) Responsibilities

• Communicates with patients by telephone, or on video; Communication can include coordination of care for the patient with CHC’s clinical departments (i.e. medical, behavioral health, dental, etc.), external community partners or programs, or other healthcare agencies as needed. It can also include data collection, basic education, and other applicable care delivery with a focus on improving health care outcomes for CHC’s patients.
• Supports the medication reconciliation processes
• Documents in each patient’s medical record the relevant clinical and administrative data and information to support the closing of care gaps and to facilitate further action by other PH team members, such as the PHRNs
• Documents discharge information in preparation for PHRN action for Transition Care Management (TCM)
• Retrieves hospital discharge summaries from the appropriate hospital or HIE portal and uploads into patient records
• Works care gap lists and other reports as directed by the Director of Population Health, the Chief Nursing Officer (CNO) or their designee
• Outreaches to patients due for Medicare Annual Wellness Visits to educate patients about the importance of AWVs
• Supports the scheduling of Health Risk Assessments with the PHRN and the subsequent scheduling of AWVs with providers.
• Assists patients who wish to establish care with CHC by directing their calls to the appropriate enabling services department/agent
• Enters data and information into payer applications when required for value based contracts
• May participate in the training of other Medical Assistant staff either on zoom or in-person if required; given this role is majority remote, in-person work will be the exception, and intermittent in nature
• Other work as delegated by the Director of Population Health, the CNO or their designee

QUALIFICATIONS

Required Skills and Education

• The successful candidate is a graduate of a nursing assistant program, is a certified paramedic or non-certified Medical Assistant
• Applicant will also possess sound organizational skills and accuracy at all levels of job
• Prior demonstrated excellent communication and customer service skills
• Bilingual

Preferred Skills

• Associate’s Degree or higher
• Expert knowledge of the electronic health record

PHYSICAL REQUIREMENTS/WORK ENVIRONMENT

• Requires manual dexterity to perform administrative tasks, minimal physical activity required
• This is a majority remote role and therefore requires a clean/organized space that is free from distractions at home to complete work (see CHC’s Remote Worker Policy for more information)
  • Demonstrates a HIPAA compliant work environment
  • Follows CHC policies around remote work space and connectivity requirements
• On rare occasions, in-person training or meetings may be required. This will be pre-arranged with the employee to ensure appropriate planning time.

ADDITIONAL QUALIFICIATIONS

• Communicates client information to providers and the clinical team accurately. Accurately takes messages, and communicates on the telephone.
• Communicates effectively with other administrative staff, collaborates with medical providers, nursing staff and members of leadership.
• Access to clients’ charts and health care information within appropriate parameters.
• Maintains client confidentiality.

Confidentiality of Information

Confidentiality of business information is a requirement.  Confidentiality must be maintained according to CHC policies

This Position is available for remote work.

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