Medical Assistant/ Care Coordinator- Community Health Worker (CHW)

Job description

The Medical Assistant Care Coordinator ensures that patients empaneled to a Care Team receive the appropriate services per their healthcare plan. The Care Coordinator will work alongside the providers and the care team to identify and address the needs of patients assigned to the care team. This position will coordinate the population health process for the care team while promoting patient-centered care. MAJOR POSITION RESPONSIBILITIES AND FUNCTIONS: - Coordinate access and completion of preventative care (HEDIS) for each patient scheduled, utilizing a huddle list, as well as other lists provided by the QI Team. Determine gaps in care and initiate the implementation of next steps for all standing order items. Coordinate care with the medical provider for additional items that require a medical provider order to be submitted. - Responsible for engaging with patients, both in-person and virtually, in a manner that utilizes evidence-based approaches (such as Motivational Interviewing) that promote collaboration between the patient and their medical team and increase the patient’s sense of control over their health. - Model commitment to continuous quality improvement by engaging in q...