The Health Coordinator II facilitates patient continuity of care with the healthcare team to ensure patients receive care that is continuous, comprehensive and coordinated across the care continuum, working cooperatively with management, providers and personnel to carry out the goals and objectives of care coordination.
ESSENTIAL FUNCTIONS OF THE ROLE
Reviews reports to identify patients with past due adult preventative, diabetes and other identified clinical services. Analyzes and compiles reports to support care coordination activities.
Conducts a review of the patient's electronic health record (EHR), and contacts patients in support of special projects identified by department manager or organizational committees. Pends orders and referrals for providers to sign-off.
Facilitates care coordination when multiple teams or disciplines are involved, considering available resources, hospital care management resources, the primary care physician (PCP) and specialists, and community resources.
Initiates contact with patient via phone, email and written letter to recommend needed services and schedule office appointments. Assist patients with self-management through approved, evidence-based education, telephonic engagement; encourages and supports patient adherence to their care plans Facilitates and monitors the patient transition from hospital to home and back to the PCP. Contacts the patient to ensure completion of follow up activities. Notifies the PCPs and clinical office staff of issues pertinent to patient care. Addresses patient and family concerns in collaboration with RN Care Manager, Social Worker, Community Health Worker or Provider, placing internal referrals to the appropriate team as required.
Identifies and facilitates referrals to community resources, such as food, transportation, medication assistance, caregiver and other needs, as requested.
Works directly with assigned patient care facilities to determine outstanding needs, and develops rapport with physicians and staff to assure seamless integration of activities with care coordination.
Collects a complete and accurate list of the patient's medications across the continuum of care including prescription, OTC products, vitamins, herbals and nutritional supplements, as required.
Tracks and reports key measures, and communicates with program leaders on status of assigned functions. Analyzes and compiles reports to support care coordination activities.
Participates in departmental committees and quality improvement initiatives as appropriate.
Acts as a team lead by overseeing and coordinating the daily activities of first level Health Coordinators, and serves as a technical expert providing training and guidance to less experienced staff.
KEY SUCCESS FACTORS
Medical Assistant certification preferred.
Thorough knowledge of processes and workflows used throughout care coordination.
Strong written and verbal communications ability.
Strong attention to detail, with time management skills.
Understanding of regulatory requirements.
Excellent listening, interpersonal and communication skills, and professional, pleasant and respectful telephone etiquette. Ability to adapt communication style to suit different audiences. Empathetic listener, sensitive, upbeat, optimistic, articulate, gracious and tactful. Ability to calm upset patients in a composed and professional demeanor.
Ability to promptly assess requests by using electronic and paper resource materials and correctly respond to patient inquiries.
Excellent data entry, numeric, typing and computer navigational skills, with attention to details.
Comfortable working in a fast paced, constantly changing and stressful environment.
Our competitive benefits package includes the following - Immediate eligibility for health and welfare benefits - 401(k) savings plan with dollar-for-dollar match up to 5% - Tuition Reimbursement - PTO accrual beginning Day 1 Note: Benefits may vary based upon position type and/or level
Baylor Scott & White Health (BSWH) is the largest not-for-profit health care system in Texas and one of the largest in the United States. With a commitment to and a track record of innovation, collaboration, integrity and compassion for the patient, BSWH stands to be one of the nation’s exemplary health care organizations. Our mission is to serve all people by providing personalized health and wellness through exemplary care, education and research as a Christian ministry of healing. Joining our team is not just accepting a job, it’s accepting a calling!