Job Title: Care Coordination Assistant- Asbury Health Center
Employment Type: Full-time
Position Highlights:
This position is responsible for assisting in providing a model of care that ensures the delivery of quality, efficient, and cost-effective healthcare services. Implementing care gap closure, supporting the provider to offer evidence-based medicine, managing the disease registry, patient and family self-management support, and care coordination activities across the care continuum. The Care Coordination Assistant supports the mission and goals of Holy Cross Health through a patient centered care approach.
Role Overview:
The Care Coordination Assistant works collaboratively with provider care teams, Care Transformation colleagues, other health care professionals, community services and other stakeholders to assist in providing quality, safe and efficiently coordinated care for all patients within Holy Cross Health's CTO network of providers.
Oversees the disease registry database.
Obtains, reviews and screens patient lists for prioritization of outreach and necessity of clinical programs. Assists patients and/or caregivers in scheduling patients' appointments and access services, as needed. Communicates and coordinates with the healthcare teams in the development of tools for optimal patient outcomes, including assisting with the set-up of chronic condition management protocols in the electronic health record (EHR), and processes for sharing/receiving continuity of care documents during care transitions. Facilitates care team meetings; prepare reports and participate in follow-up.Works collaboratively with Providers, care teams and colleagues to promote continuous quality improvement and overall success of advanced primary care within the practice.
Support Patients and Caregivers in Self-Management Oversees Care Coordination.
Works with low-risk and risking-risk patients to create a plan for Health Behavior Change.
Elicits patient goals, design and support individualized treatment and self-care plans that are aligned with the individual's needs, goals and preferences, and follow-up with the patient as appropriate. Provides or arranges needed patient education.
Effectively assesses and coach patients through the behavior change process.
Proactively act as the patient’s advocate, responding to and working to resolve patient concerns
Assists as liaison with patients and their families to provider care teams, clinical colleagues, other departments, community services and outside stakeholders.
Acts as a liaison for hospitalized patients and the provider care teams.
Consults with referring source or provider care team to obtain and review the plan of care, and assist patients in following the plan of care
Additional Benefits: Tuition reimbursement, free parking, employee discounts.
Quality of Life: Flexible work schedules to support a healthy work-life balance.
Advancement: Opportunities for professional growth within the organization.
Location: Holy Cross Health operates two hospitals and four healthcare centers, all within a short driving distance from Washington, DC, and Baltimore, MD.
Reporting to: Reports to the Director, Population Health
Minimum Education, licensure/certification required:
Licensed Practical Nurse (LPN) or Certified Medical Assistant (CMA), required.
High school diploma required; Bachelor's Degree preferred.
Skills Required:
Five years’ experience in a healthcare setting, preferably an ambulatory setting. Moderate to high computer literacy with willingness to learn, ability to document/access effectively within multiple electronic health records, health-related databases and other care related platforms. Knowledge of Microsoft Office suite software required. Knowledge of performance improvement, billing, coding, and documentation requirements highly desired. Knowledge of evidence-based behavioral change methodologies and motivational coaching techniques highly desired. Must be collaborative and comfortable operating in a shared leadership environment. Demonstrate ability to function effectively in a dynamic, fast-paced environment. Demonstrates customer focused interpersonal skills to interact in an effective manner with practitioners, the interdisciplinary health care team, community agencies, patients, and families with diverse opinions, values, and religious and cultural ideals. Demonstrates ability to work autonomously and be accountable for outcomes.
Pay Range: $16.25-$29.02
Pay is based on experience, skills and education. Exempt positions under the Fair Labor Standards Act (FLSA) will be paid within the base salary equivalent of the stated hourly rates. The pay range may also vary within the stated range based on location.
Holy Cross Health is an Equal Employment Opportunity (EEO) employer. Qualified applicants are considered for employment without regard to Minority/Females/disabled/Veteran (M/F/D/V) status
About Us:
Holy Cross Health is a Catholic, not-for-profit health system serving more than 240,000 individuals annually from Maryland's two largest counties—Montgomery and Prince George's counties. Holy Cross Health has earned numerous national awards, clinical designations, and accreditations across a wide range of specialties for providing innovative, high-quality health care services.
Our Commitment to Diversity and Inclusion
Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.