Patient Coordinator Care Management

About This Role

This role supports patients who are engaged with the Penn Partners in Care Management Program. The Patient Coordinator collaborates with the Care Manager and the entire Care Team to coordinate services and connect with patients, aiming for positive health outcomes. This involves telephonic, electronic, and in-person communications with patients and coordination with all care providers.

Responsibilities

• Connect with patients on a regular basis to gauge completion of specific health interventions outlined in the Care Plan, such as appointments, medication compliance, use of community resources, and other recommended follow-up activities
• Respond to patient questions or concerns by telephonic or other methods of communication (MPM, etc.)
• Perform daily telephonic or electronic ED outreach using established guidelines and questionnaires
• Coordinate patient needs (e.g., social service, health, and medication) in cooperation with interdisciplinary providers including PCP, social work, pharmacists, and payers
• Interact with patient service representatives or schedule follow-up for ED, hospital follow-up, and acute care appointments
• Monitor delivery of care through documentation and tracking of interventions in PennChart (specialty visit follow-up, labs, diagnostic studies, etc.)
• Coordinate completion of forms or scheduling for transportation and durable medical equipment based on practice-specific needs
• Evaluate outcomes of care with the interdisciplinary care team during case reviews, providing the team with updates and progress of care plan for patients
• Collaborate daily with the Care Manager to assist in meeting patient goals
• Collaborate with the Community Health Worker regarding patient goals and concerns
• Collaborate with the Social Worker or Pharmacist to follow-up on access to resources
• Collaborate with the provider and medical assistants, as needed
• Document in PennChart using the Care Management Navigator regarding coordination activities following established workflows and processes
• Perform duties in accordance with Penn Medicine and entity values, policies, and procedures
• Perform other duties as assigned to support the unit, department, entity, and health system organization

Requirements

• H.S. Diploma/GED and 3+ years of relevant health care experience in a similar role required
• Associates Degree and 1+ years health-related or science area of study preferred
• Bachelors Degree and 0-1 years of health-related or science area of study preferred

Benefits

• Comprehensive compensation and benefits program
• Prepaid tuition assistance programs

Important Details