Care Coordinator

Job Description

Job Description

Job Summary

The Care Coordinator is responsible for supporting multiple clinic locations by coordinating patient care activities that improve quality outcomes, close care gaps, and support value-based reimbursement initiatives. This role works closely with providers, clinical staff, and insurance payers to ensure patients receive appropriate preventive and chronic care services. The Care Coordinator manages Chronic Care Management (CCM) and Transitional Care Management (TCM) programs, facilitates timely patient follow-up, and ensures accurate documentation to meet regulatory and payer requirements.

This position will be officed in the main hospital building, and travel to primary and specialty clinics will be required as needed..

Knowledge, Skills & Abilities

● Excellent organizational, communication, and interpersonal skills

● Strong proficiency in AthenaOne EHR and healthcare documentation

● Ability to maintain confidentiality and compliance with HIPAA and hospital policies

● Adaptability to a fast-paced and rapidly changing environment and remained focused on task at hand

● Attention to detail and regulatory compliance

● Patient-centered communication

● Data tracking and performance monitoring

● Interdepartmental collaboration

● Problem-solving and workflow improvement

● Strong organizational, communication, and time management skills.

● Ability to manage multiple priorities across multiple clinic location

● Identify and address care gaps through payer reports, EMR registries, and internal quality dashboards.

● Collaborate with insurance companies and care management programs to support incentive-based reimbursement initiatives.

● Coordinate Chronic Care Management (CCM) services, including patient enrollment, monthly outreach, care plan documentation, and compliance with CMS guidelines.

● Manage Transitional Care Management (TCM) workflows, including post-discharge outreach within required timeframes, medication reconciliation, and scheduling follow-up visits.

● Contact patients to schedule preventive, chronic care, and post-discharge appointments in accordance with clinical guidelines.

● Work closely with providers and clinic staff to ensure timely completion of screenings, labs, and preventive services.

● Track and document all patient interactions, care coordination activities, and outcomes in the electronic medical record (EMR).

● Monitor performance metrics related to quality measures, care gap closure, and program participation.

● Assist with audit preparation and ensure compliance with Medicare, Medicaid, and commercial payer requirements.

● Provide patient education related to chronic conditions, preventive care, and follow-up compliance.

● Support workflow standardization across multiple clinic locations to improve efficiency and care delivery.

Other

● Support organizations Compliance & Privacy Program and immediately report any patient safety or compliance concerns

● Perform other related duties as assigned

Education & Experience

● Required: Associate’s degree or higher in healthcare administration, nursing, or related field

● Required: Minimum two (2) years of healthcare experience as an RN or LPN in a clinic or hospital setting, preferably in care coordination, population health, or clinic operations

● Knowledge of Chronic Care Management (CCM) and Transitional Care Management (TCM) programs strongly preferred.

● Familiarity with Medicare, Medicaid, and value-based care models.

● Experience working with Athena EHR.

● Required: Registered Nurse (RN) or Licensed Practical Nurse (LPN)

● Preferred: Bachelor of Nursing (BSN) or higher – Louisiana Licensure

Physical & Environmental Demands

● Frequent communication with patients, providers, insurance representatives, and administrative staff

● Frequent and regular travel between outpatient clinic(s)

● Ability to adapt to frequent interruptions and changing priorities

Performance Metrics May Include:

● Care gap closure rates

● CCM and TCM enrollment and completion rates

● Patient follow-up compliance

● Quality measure performance (e.g., HEDIS, CMS metrics)

● Documentation accuracy and audit readiness

Equal Employment Opportunity

Morehouse General Hospital is an Equal Opportunity Employer. All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, or disability.

About Morehouse General Hospital
Founded in 1930, Morehouse General Hospital is a 49-bed community hospital dedicated to delivering high-quality, compassionate care to residents of Northeast Louisiana and Southeast Arkansas. MGH offers a broad range of inpatient and outpatient services and is deeply committed to serving its community through strong clinical programs, advanced technology, and personalized care.

Company Description

About Morehouse General Hospital\r\nFounded in 1930, Morehouse General Hospital is a 49-bed community hospital dedicated to delivering high-quality, compassionate care to residents of Northeast Louisiana and Southeast Arkansas. MGH offers a broad range of inpatient and outpatient services and is deeply committed to serving its community through strong clinical programs, advanced technology, and personalized care.