Company: Missouri Primary Care Association (MPCA)
Job Title: Care Coordinator
Job Classification: Non-Exempt, Full-Time
Work Schedule: Monday through Friday, 8 hours/day
Reporting Structure: Director of Compliance & Valued Based Programs
Location:  Eligible for Remote

Primary Accountability:
The Care Coordinator ensures efficiency and effectiveness in the patient experience and patient navigation. They will work directly with network patients to focus on coordination of care including routine communication directly with patients, collaborating with care teams at the health centers, facilitating care transitions, connecting patients with referrals/resources, and providing linkages to other community-based or social services. This includes quality

improvement and assurance reviews involving patient navigation, management and support by coordinating with other healthcare members to provide quality care for every patient.

Major Duties:

• Conducts and reviews patient assessments including but not limited to health risk assessments, needs assessments, treatment planning, and reassessment services.
• Performs care coordination activities as needed for individual patient needs including but not limited to transitional care and referral care management.
• Designs and delivers individualized coaching by working with providers to identify site‐specific needs and opportunities, prioritizing areas of focus, and identifying available and needed resources.
• Designs and delivers individualized coaching for workflow implementation and optimization to improve and/or enhance disease management and treatment that is patient centered.
• Reviews patient cases with care teams and provides advice, direction, and support.
• Organizes and leads training sessions, on process recommendations and updates.
• Meets with providers, patients, and care team to review and update care coordination activities.
• Participates in the Missouri Quality Improvement Network and supports member Federally Qualified Health Centers (“FQHC”) in quality improvement activities, including quality improvement and performance improvement coaching.
• Works collaboratively with other practice coach and data analyst staff for reporting, training, and program coordination.
• Works collaboratively with Missouri Health Plus to support member health centers on value-based care initiatives.
• Facilitates specific projects among member and partner organizations, including State agencies and local/regional organizations as assigned.
• Performs additional duties as assigned.

Qualifications:

• Bachelor’s or associate degree in nursing, public health, health care administration, or other related health care field. Medical Assistant certification considered.
• Computer basic literacy required.
• LMSW/LCSW/LPN/RN or EMT/Paramedic certification or license preferred, experienced Medical Assistant considered.
• 2 years of case management or care coordination experience preferred.
• 2+ years experience working in an outpatient clinic setting or in an area of quality improvement, clinic/practice management, and/or clinical area preferred.
• Experience with MO based Federally Qualified Health Center or outpatient primary care practice preferred.
• Training and/or certification in quality improvement, risk management, patient safety, patient‐centered medical home preferred.

Work Environment:

• Professional and deadline-oriented environment in an office setting.
• Interaction with internal and external customers.
• Job duties may be performed from a remote location, after initial training.

Additional Duties:
Additional duties and responsibilities may be added to this job description at any time. The job description does not state or imply that these are the only activities to be performed by the employee(s) holding this position. Employees are required to follow any other job-related instructions and to perform any other job-related responsibilities as requested by their supervisor.