Care Coordinator - Family Practice

## Description

**Family Practice Care Coordinator**

Cumberland Family Medical Center (CFMC) operates a Federally Qualified Health Center (FQHC) offering a wide range of health and social services at multiple sites throughout Kentucky. We seek employees who support our mission and who actively contribute to our service-driven environment by enhancing the patient experience and improve productivity. CFMC offers compassionate care, uncompromising service and clinical excellence. We offer a collaborative environment with excellent benefits, wage/salary commensurate with experience and relevant work experience.

**Job Duties:**

• Medicare Annual Wellness Visit
• Monitor schedule and daily huddle for eligible Medicare patients and convert to annual wellness visit
• Contact patients via phone or letter regularly to schedule appointments for visit
• Perform wellness visit per Medicare guidelines using IMS template
• Assist patient with community resources as needed
• Accountable Care Organization (ACO)
• Manage patient worklists and huddles by utilizing software reporting programs
• Complete Transitional Care Management (TCM) calls for patients within 48 hours of discharge
• Chronic Disease Education
• Provide disease education and management upon provider request
• Utilize reporting system to generate huddle reports daily to share with clinical staff
• Monitor UDS metrics and provide feedback to clinic staff
• Chronic Care Management (CCM)
• Generate report of Medicare patients eligible for CCM
• Contact patient to offer CCM services and document consent
• Utilize templates to document CCM services
• Other duties as assigned by clinic provider with approval from Director of Quality Improvement.

## Qualifications
**Qualifications:**

• Associate’s degree in nursing or higher
• Valid LPN or RN license
• CPR certification
• Experience in medical office setting preferred
• Maintenance of required continuing education courses

• **Schedule Requirements:**
• Full-time position, 5 days per week, 100% clinic-based, in person work required.
• Work schedules are set at the discretion of CFMC and may be adjusted at any time based on the operational needs of the organization.
• **Compensation:** Negotiable based on experience
• **Benefits:** Health, Vision, Dental, Life, STD, LTD, 401K, PTO, and Holidays