Preventative Care Coordinator

Primary functions

Under the supervision of the Quality Manager, the preventive care coordinator will play a vital role in supporting the Neighborhood Health’s quality improvement initiatives by identifying and engaging patients who are overdue for care. This position is responsible for outreach to patients, scheduling necessary appointments, providing education on the importance of preventive and chronic care services, and ensuring follow-through to close care gaps. The role supports improved health outcomes, patient satisfaction, and compliance with value-based care metrics. Data and outreach will be reported out to the Neighborhood Health Quality Committee, and Neighborhood Health Leadership team.

Demonstrates commitment to Neighborhood Health’s mission of improving health and advancing health equity in Alexandria, Arlington, and Fairfax by providing access to high quality primary care regardless of ability to pay.

Duties/ Responsibilities

• (Essential
• Functions: Duties and responsibilities noted with bullets are considered to be the essential functions of the job).
• Conduct outbound outreach to patients with open care gaps such as screenings, immunizations, chronic care management, etc. through phone calls, text messages, and letters.
• Educate patients on the importance of recommended services and how they contribute to overall health.
• Schedule appointments with appropriate providers or services to address care gaps.
• Track patient progress and follow up to ensure completion of scheduled services.
• Document all outreach and follow-up activities accurately in the electronic health care record (EHR)
• Partners with the care team to ensure patients receive the highest quality care needed based on preventative services and chronic illness management.
• Foster positive relationships with all Managed Care Organizations to ensure patients have a medical home and clinical care gaps are addressed
• Meet routinely with supervision team to report on project progress and troubleshoot issues
• Ability to exercise independent judgment when appropriate.
• Employee will regularly navigate medical systems and correspond with clinic staff regarding clinical care gaps
• Displays a high level of organization and time management skills to ensure patients have adequate follow-up and reported data is accurate.