Medical Assistant Care Coordinator (WHWC)

Essential Duties:


* Works with Care Coordination RN/LVN to promote and reinforce patient centered medical home (PCMH) concepts with patients and staff.


* Coordinates care for designated patients by collaborating with MHM primary care providers, the integrated healthcare team, specialists, Clinical CHWs, Wesley Nurses, patients, and families to ensure seamless navigation through the healthcare system.


* Support patients in navigating follow-up care after an ER visit, including scheduling appointments, managing medication needs, and assisting in the coordination of specialty referrals to ensure effective care transitions.


* Follow established processes aimed to improve patient's health outcomes.


* Provide education to patients and/or family regarding patient's condition and ongoing care.


* Responds to inquiries and calls from patients, providers, integrated healthcare team and external resources.


* Assists in the resolution of complaints, requests, and inquiries from patients.


* Monitor patients for changes in clinical symptoms in-person at clinic, at home or by phone.


* Conducts home visits as needed to assess patient needs, provide support, promote continuity of care and improve patient's health outcomes.


* Work with external agencies for welfare checks when appropriate.


* Occasionally takes and documents patient vital signs (blood pressure, pulse, weight, height, other measures as assigned) both in the clinic and patient's home setting.


* Document tracked patient outcomes using accurate and appropriate clinical terminology.


* Assist with transition of care to ensure continuity and support as patients move between healthcare settings.


* Performs other duties as assigned.

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily.

The requirements listed below are representative of the knowledge, skill, and/or ability required.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education/Experience:

High school diploma or general education degree (GED) required.

Graduation from an accredited Medical Assistant program is also required.

One year of experience in a clinical setting is required.

Language Ability:

Proficient in reading and interpreting documents with strong attention to detail, and capable of composing clear and concise written correspondence.

Skilled in effectively presenting information in one-on-one and small group settings, particularly in interactions with patients, clients, providers and team members.

Experience in providing verbal translation between providers and patients/clients is essential to ensure accurate and culturally appropriate communication.

Fluency in English is required, and bilingual proficiency in Spanish is mandatory for this role.

Reasoning Ability:

Ability to apply understanding to carry out instructions.

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