ECM Care Coordinator (Justice Involved) - Baker St

Clinica Sierra Vista is excited to be one of the largest Federally Qualified Health Centers in the Nation! We're honored to serve the men and women of the fields. We also offer care and support to the inner city, the rural and isolated, those of low, moderate, and fixed incomes, and families from an array of cultural backgrounds who speak several languages. We don't inquire about immigration status because we simply don't need to know. If you come to us, we will treat you like any other patient.

As we grow our team, we are looking for individuals who believe the patient is always #1.

Why work for us?

• Competitive pay which matches your abilities and experience

• Health coverage for you and your family

• Generous number of vacation days per year

• A robust wellness plan and health club discounts

• Continuing education assistance to grow and further your talents

• 403(B) plan with company matching

Intrigued? We'd love to hear from you! Please review the job details below and then click "apply."

We're looking for someone to join our team as an ECM- Care Coordinator (Justice Involved) who:

The Care Coordinator will report to the Practice Manager. Care Coordination serves as a main contact for enrolled Enhanced Care Management members and will be responsible to identify and connect Justice Involved (JI) population to community resources and assist in medical referral follow through from members.. The Care Coordinator is responsible to identify and connect member to community resources and assist in medical referral follow through from members.

Essential Functions:

• Meet with all new patients, explaining The Enhanced Care Management (ECM) program to members.

• Complete the New Enrollment Assessment for all new members

• Be a point of contact for members enrolled in the ECM program.

• Connect members to community resources

• Ensure follow up for members for referrals, including community related referrals and medical referrals

• Complete assessment for plan of care based on social determinates of health.

• Complete the flowsheets for member visits

• Maintain active engagement and interactions with members enrolled in the program to maintain the required one encounter per member per month.

• Update goal progression for members enrolled in the ECM program.

• Provide updates to Case Manager on the assigned members progress

• Participate in Interdisciplinary Care Team meetings

• Resolves unassigned patients by reviewing appointment history (and possibly the clinical record) to determine appropriate assignment.

• Collaborates with appropriate site based on members needs

• Communication with outside provider to ensure continuity of care

• Proactively engage priority patients to promote availability of expanded access clinic and reduce unnecessary Emergency Room utilization.

• Run, manage and analyze standard CSV reports.

• Oversee and analyze data from assigned panels in regard to CSV-priority conditions. This includes the running of reports within the CSV computer structure, Excel etc.

• Responsible for clinic-wide compliance with CSV, PCMH, CMS, Meaningful Use and California Department of Public Health (CDPH) requirements.

• Clinic-wide required to meet or show consistent improvement on CSV clinical quality goals.

You'll be successful with the following qualifications:

• Education: Medical Assistant certification or program completion preferred.

• Computer proficiency: Excel, Word, Outlook, PDF, Electronic Health Records, etc.

• Bilingual (Spanish-English) preferred.

• Maintain excellent internal and external customer service at all times.

• Maintain the highest degree of confidentiality possible when performing the functions of this department.

• Possess the tact necessary to deal effectively with patients, providers, and employees, while maintaining confidentiality.

• Must have lived in experience with the Justice Involved Population.

Clinica Sierra Vista values human rights, goodwill, respect, inclusivity, equality, and recognizes that the organization derives its strength from a rich diversity of thoughts, ideas, and contributions. As leaders in healthcare industry, we aspire to be an employer of choice by promoting an organizational culture that reflects these core values. We seek to attract, develop, and retain a talented and dedicated workforce where people of diverse races, genders, religions, cultures, political affiliations and lifestyles thrive. Our goal is to create a welcoming and inclusive environment that empowers our employees to provide the highest level of service to our community of residents and businesses; they're counting on us.

Clinica Sierra Vista is an equal opportunity employer and strives to attract qualified applicants from all walks of life without regard to race, color, ethnicity, religion, national origin, age, sex, sexual orientation, gender identity, gender expression, marital status, ancestry, physical disability, mental disability, medical condition, genetic information, military and veteran status, or any other status protected under federal, state and/or local law. We aim to create an environment that celebrates and embraces the diversity of our workforce. We welcome you to join our team!