Medical Care Coordinator

Position Summary

The Medical Care Coordinator supports patient care coordination, access to healthcare coverage, and Value-Based Care (VBC) initiatives. This position serves as a liaison between patients, providers, insurers, and community partners to improve access to care, address barriers, and support positive health outcomes. Responsibilities include patient outreach, insurance enrollment assistance, care gap closure activities, and care coordination for high-risk and underserved populations.

• ESSENTIAL DUTIES AND RESPONSIBILITIES Educate patients on available health center services, benefits, and care coordination resources.
• Assess patient health and social needs and identify barriers to care.
• Develop and coordinate patient-centered care plans with patients, providers, and caregivers.
• Assist patients with Medicaid recertification, renewal applications, and reenrollment processes and educate patients on required documents, deadlines, and eligibility requirements.
• Coordinate Medicare enrollment assistance for eligible patients.
• Maintain current knowledge of Medicaid, Medicare, and other public assistance programs.
• Coordinate care for patients requiring assistance with healthcare access, insurance coverage and follow-up.
• Assist patients in navigating healthcare services, community resources, and social support programs.
• Collaborate with care teams to improve patient compliance with treatment plans and recommended services.
• Coordinate referrals and services with healthcare providers and community resources.
• Perform patient outreach to address preventive care and quality measure gaps, including but not limited to: lead screenings, annual wellness visits, well-child care visits (WCC), pap smear clinics, mammography screenings, and other preventive and quality initiatives as assigned.
• Conduct outreach to eligible patients to connect them to Nurse for My Health GPS Program services.
• Schedule appointments and provide reminders to support completion of recommended services.
• Document patient encounters, outreach efforts, enrollment assistance, and outcomes in the EMR.
• Retrieve and upload ED/ER discharge summaries in the EMR for provider follow-up.
• Adhere to clinic departmental policies and procedures, which include Patient Safety initiatives, Patient Rights, and Health Insurance Portability and Accountability Act (HIPAA) Privacy standards.