Job Description

Job Title: Medical Care Coordinator

Location: 1575 Blue Hill Avenue, Mattapan, MA 02126

Reports To: Clinical Support Supervisor

Type: Full Time

Salary: Salary and benefits for this position are competitive and commensurate with experience.

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Under the direction of the Director of Clinical Support Supervisor, the Medical Care Coordinator will hold a hybrid role of .5 FTE Medical Assistant and .5 FTE Medical Care Coordinator. As the Medical Care Coordinator will work collaboratively with medical providers and nursing

staff to support patients with social and clinical needs. The Care Coordinator will work with

patients and the medical team to coordinate medical services, including specialty care and home

health services, assist with transportation, and connect patients with additional or outside

services to assure that patients' medical needs are optimally managed. As a Medical Assistant the staff will work with clinical providers and staff to room patients, coordinate care, follow up with patients and manage workflow of scheduled patients.

Responsibilities:

5 FTE Medical Care Manager

Clinical Duties

• Coordinate referrals to community-based health services such as visiting nurse agencies (VNA), Personal Care Attendant Services (PCA), Home Physical Therapy, Home Health Aid Services (HHA), etc.
• Make referrals to nutritional services such as· Community Servings and WIC
• Partner with complex care teams at BHN and other agencies to execute plans of care for chronic disease management
• Coordinate transportation for patients to medical appointments at MCHC or specialists via PT-1 transportation, Lyft, or other sources; support patients in applying for The Ride or discounted Charlie Cards
• Assist with request for and receipt of durable medical equipment
• Assist patients and providers with timely completion and submission of medical forms to appropriate agencies
• Support patients in optimizing medication adherence through logistical troubleshooting (home delivery of medication) and organizational tools (pill organizers, phone alarms)
• Identify and connect patients requiring assistance with insurance registration or reinstatement with financial counselor and/or other MCHC Care managers
• Coordinate internal referrals to individuals and/or departments at MCHC, including but not limited to: Behavioral Health, PrEP/HIV Navigator, and Nutrition
• Partner with patients and providers in executing treatment plans utilizing cultural sensitivity and appropriate health literacy
• Fulfill duties as mandated reporter per Massachusetts law when abuse or neglect is suspected

Administrative Duties

• Document all encounters with patients, providers, and/or outside agencies in the electronic medical record (EMR) in compliance with medical-legal standards and regulations
• Complete necessary referrals for services recommended for patients
• Obtain a signed Release of Information for any collateral contacts, care coordination, or family contacts completed on a patient's behalf
• Manage care coordination phone calls and requests received through various call pools in the EMR.

5 FTE Medical Assistant

Clinical Duties

• Perform patient care services such as vital signs, administer nebulizer treatments, weighs, EKG’s, O2 saturation, hearing/vision test, peak flow measures and finger stick/blood glucose levels, etc.
• Document initial history, i.e., baseline complaint, and purpose of visit and direct patient care services provided by the Medical Assistant in the patient medical record.
• Reconciliation of the patient’s medications during the initial assessment.
• Assist provider with procedures and chaperone as necessary.
• Perform urine pregnancy test, routine urinalysis and rapid strep test.
• Prepare examination room, prep patient for examination.
• Collect, label and prepare specimens and cultures for the lab.
• Provide translation as needed.
• Check schedules prior to the next clinic day to determine the patient’s need for the visit.
• Huddling with providers about their scheduled patients.

Administrative Duties

• Stock examination rooms with clinical supplies.
• Send no-show/DNKA letters
• Complete forms
• Answer telephone, take and disseminate messages as needed.
• Monitor and complete flow sheets as directed by provider.
• Participates in Health Center meetings, as required.
• Assigned to call center as designated by the nurse supervisor and communicate with nurses and providers regarding calls designated for a particular provider.

Performs other related duties as required or assigned by the Director of Clinical Services

Requirements

Education – Completed Medical Assistant training in accredited program is required. 1-2 years experience in social services or equivalent skills preferred. Current certification in Cardio-Pulmonary Resuscitation (CPR).

Clinical Knowledge – The ideal candidate must have one year of recent clinical experience in a hospital or community health care setting, must be flexible, organized, and able to stand on their feet for extended periods of time and be culturally/ethnically sensitive. Experience in a community health setting with persons of diverse cultures is a plus.

Communication and Interpersonal Skills - Bilingual in Haitian-Creole or Spanish preferred. Comfort utilizing medical interpreter services required. ideal candidate will have excellent communication skills, both written and verbal, to effectively interact with staff, physicians, patients, and external stakeholders.

Experience – 3 or more years of experience working with a diverse population in a health care setting is preferred.

Analytical Skills – Advanced computer operations skills, such as Excel and Microsoft Office, are essential. Experience with EPIC OCHIN is a plus.

Adaptability and Resilience - The ability to thrive in a fast-paced and evolving healthcare environment, adapt to changing priorities, and manage multiple projects simultaneously.

Ethical and Professional Conduct - Demonstrated commitment to ethical practices, patient-centered care, and maintaining confidentiality.