Care Coordinator - Family Practice

Care Coordinator - Family Practice

Cumberland Family Medical Center (CFMC) operates a Federally Qualified Health Center (FQHC) offering a wide range of health and social services at multiple sites throughout Kentucky. We seek employees who support our mission and who actively contribute to our service-driven environment by enhancing the patient experience and improve productivity. CFMC offers compassionate care, uncompromising service and clinical excellence. We offer a collaborative environment with excellent benefits, wage/salary commensurate with experience and relevant work experience.

Job Duties

• Medicare Annual Wellness Visit
  • Monitor schedule and daily huddle for eligible Medicare patients and convert to annual wellness visit
  • Contact patients via phone or letter regularly to schedule appointments for visit
  • Perform wellness visit per Medicare guidelines using IMS template
  • Assist patient with community resources as needed
• Accountable Care Organization (ACO)
  • Manage patient worklists and huddles by utilizing software reporting programs
  • Complete Transitional Care Management (TCM) calls for patients within 48 hours of discharge
• Chronic Disease Education
  • Provide disease education and management upon provider request
• Utilize reporting system to generate huddle reports daily to share with clinical staff
• Monitor UDS metrics and provide feedback to clinic staff
• Chronic Care Management (CCM)
  • Generate report of Medicare patients eligible for CCM
    • Contact patient to offer CCM services and document consent
    • Utilize templates to document CCM services
• Other duties as assigned by clinic provider with approval from Director of Quality Improvement.

Qualifications

• Associate's degree in nursing or higher
• Valid LPN or RN license
• CPR certification
• Experience in medical office setting preferred
• Maintenance of required continuing education courses

Full-time position, 5 days per week, 100% clinic-based, in person work required. Work schedules are set at the discretion of CFMC and may be adjusted at any time based on the operational needs of the organization.

Compensation: Negotiable based on experience Benefits: Health, Vision, Dental, Life, STD, LTD, 401K, PTO, and Holidays