Community Wellness Coach - Primary Care - FT - Days - MRH - Pembroke Road - Memorial Healthcare System
Hollywood, FL
About the Job
At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care. An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience.
Summary:
Works collaboratively with physicians, staff, and other health care professionals to provide care coordination across the health continuum for all assigned patients ensuring that safety, best practice, and high quality standards of care are maintained. Serves as a mentor, educator, and advocate for personal health and wellness.
Responsibilities:
Uploads and tracks patient records in Avality to ensure patient population health continuum is compliant based on HEDIS measurements.Assist patient in the comprehension of complex instructions and facilities conflict resolution. Demonstrates strong organizational skills, priority setting skills and has the ability to multi-task various competing tasks. Must be able to learn and apply large amount of technical and procedural information. Must be able to communicate effectively verbally and in writing.To independently analyze processes, high- risk patient information, identify problems and trends, and develop effective solutions and strategies. Facilitates care plans, provide updates to the team, and documents efforts. Uses varies forms of communication methods including but not limited to face-to face, telehealth, email, and mail. Works closely with physicians and the multidisciplinary care management teams.Delivers general and specialized education on preventive and chronic care conditions measures, including weight and stress management, risk prevention and reduction, and living with specific health conditions. Responsible for regulatory compliance of Healthcare Effectiveness Data and Information Set (HEDIS) measures which are monitored and reviewed quarterly to ensure care gap metrics are achieved. Work with physicians to reduce emergency room utilization for avoidable visits through outreach and providing alternative resources.Generate/analyze patient reports that are reviewed by senior at patient re-cap meetings along with key business stakeholders (Physicians, Pharmacists, and Nurses).May consult and/or train new staff, students, and interns. May serves as backup for the Medical Assistant in performing basic medical care and exams.Assist with the identification, determination and need for systems, process workflows, equipment and supplies, such as: Remote Patient Monitoring Devices (BP machine) and Colorectal Cancer Screening Kits. Monitors usage and oversees proper working order of equipment and ensures adequate supplies.Adheres to CMS compliance regarding Medicaid/Medicare regulations. Ensures regulatory compliance.Interviews and assesses patients and/or family, caregivers, and/or legal representatives. Provides outreach to patients and families to ensure care coordination. Determines, prioritizes, provides and/or arranges for needed internal and external services. Obtains medical authorizations and scheduling primary care, specialist care, lab, and diagnostic testing appointments.Provides assessment and coaching to individuals to help them develop and achieve wellness goals, including personal empowerment, lifestyle changes, and behavior modification. Assesses for Social Determinants of Health and provides community resources to leverage social barriers.
Competencies:
ACCOUNTABILITY, ANALYSIS AND DECISION MAKING, CUSTOMER SERVICE, DOCUMENTING, EFFECTIVE COMMUNICATION, PROBLEM SOLVING, RESPONDING TO CHANGE, STANDARDS OF BEHAVIOR
Education and Certification Requirements:
Accredited Program: Medical Assistant (Required)BLS American Heart E-Card (BLS AHA ECARD) - American Heart Association (AMERICAN HEART), BLS American Heart RQI E-Card (BLS AHA-RQI ECARD) - American Heart Association (AMERICAN HEART), BLS Cert American Heart_non ecard (BLS AHA) - American Heart Association (AMERICAN HEART), BLS Certification Grace (BLS GRACE) - Employee Grace Period for Essential Credential (GRACE), BLS Cert Red Cross (BLS RC) - Red Cross (RED CROSS), Fingerprint Screen (FINGERPRNT) - Florida Department of Children's & Family (DCF)
Additional Job Information:
Complexity of Work: Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision. Excellent communication and presentation skills effective in working with all levels of clinicians (physicians, mid and senior levels management, Nurses, Allied, office staff, and internal/external customers. Self-starting, meticulous, and forward thinking with demonstrated case management and organizational skills. Illustrated knowledge of both healthcare operations as well as the health insurance/health plans industry and Epic expertise. Must be able to work in a stressful work environm
Summary:
Works collaboratively with physicians, staff, and other health care professionals to provide care coordination across the health continuum for all assigned patients ensuring that safety, best practice, and high quality standards of care are maintained. Serves as a mentor, educator, and advocate for personal health and wellness.
Responsibilities:
Uploads and tracks patient records in Avality to ensure patient population health continuum is compliant based on HEDIS measurements.Assist patient in the comprehension of complex instructions and facilities conflict resolution. Demonstrates strong organizational skills, priority setting skills and has the ability to multi-task various competing tasks. Must be able to learn and apply large amount of technical and procedural information. Must be able to communicate effectively verbally and in writing.To independently analyze processes, high- risk patient information, identify problems and trends, and develop effective solutions and strategies. Facilitates care plans, provide updates to the team, and documents efforts. Uses varies forms of communication methods including but not limited to face-to face, telehealth, email, and mail. Works closely with physicians and the multidisciplinary care management teams.Delivers general and specialized education on preventive and chronic care conditions measures, including weight and stress management, risk prevention and reduction, and living with specific health conditions. Responsible for regulatory compliance of Healthcare Effectiveness Data and Information Set (HEDIS) measures which are monitored and reviewed quarterly to ensure care gap metrics are achieved. Work with physicians to reduce emergency room utilization for avoidable visits through outreach and providing alternative resources.Generate/analyze patient reports that are reviewed by senior at patient re-cap meetings along with key business stakeholders (Physicians, Pharmacists, and Nurses).May consult and/or train new staff, students, and interns. May serves as backup for the Medical Assistant in performing basic medical care and exams.Assist with the identification, determination and need for systems, process workflows, equipment and supplies, such as: Remote Patient Monitoring Devices (BP machine) and Colorectal Cancer Screening Kits. Monitors usage and oversees proper working order of equipment and ensures adequate supplies.Adheres to CMS compliance regarding Medicaid/Medicare regulations. Ensures regulatory compliance.Interviews and assesses patients and/or family, caregivers, and/or legal representatives. Provides outreach to patients and families to ensure care coordination. Determines, prioritizes, provides and/or arranges for needed internal and external services. Obtains medical authorizations and scheduling primary care, specialist care, lab, and diagnostic testing appointments.Provides assessment and coaching to individuals to help them develop and achieve wellness goals, including personal empowerment, lifestyle changes, and behavior modification. Assesses for Social Determinants of Health and provides community resources to leverage social barriers.
Competencies:
ACCOUNTABILITY, ANALYSIS AND DECISION MAKING, CUSTOMER SERVICE, DOCUMENTING, EFFECTIVE COMMUNICATION, PROBLEM SOLVING, RESPONDING TO CHANGE, STANDARDS OF BEHAVIOR
Education and Certification Requirements:
Accredited Program: Medical Assistant (Required)BLS American Heart E-Card (BLS AHA ECARD) - American Heart Association (AMERICAN HEART), BLS American Heart RQI E-Card (BLS AHA-RQI ECARD) - American Heart Association (AMERICAN HEART), BLS Cert American Heart_non ecard (BLS AHA) - American Heart Association (AMERICAN HEART), BLS Certification Grace (BLS GRACE) - Employee Grace Period for Essential Credential (GRACE), BLS Cert Red Cross (BLS RC) - Red Cross (RED CROSS), Fingerprint Screen (FINGERPRNT) - Florida Department of Children's & Family (DCF)
Additional Job Information:
Complexity of Work: Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision. Excellent communication and presentation skills effective in working with all levels of clinicians (physicians, mid and senior levels management, Nurses, Allied, office staff, and internal/external customers. Self-starting, meticulous, and forward thinking with demonstrated case management and organizational skills. Illustrated knowledge of both healthcare operations as well as the health insurance/health plans industry and Epic expertise. Must be able to work in a stressful work environm
Source : Memorial Healthcare System