Care Coordinator RN

Care Coordinator

About Us: 
Family Care of the Bluegrass - Lawrenceburg is a mission-driven, patient-centered organization committed to providing comprehensive, high-quality health care to underserved populations. We strive to create a welcoming and inclusive environment that supports health equity and improves outcomes for our diverse community. 

Position Summary: 
The Care Coordinator serves as a key member of the clinical team, working collaboratively to support patients in navigating the healthcare system. This position is responsible for coordinating care across services, advocating for patients, and ensuring access to the resources needed for improved health outcomes. 

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 patient experience and improving 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 Functions/Responsibilities:

• Medicare Annual Wellness Exams
• Chronic Care Management (CCM)/Principal Care Management (PCM)
• Run report on Medicare patients eligible for wellness exam quarterly
• Contact patients via phone or letter regularly to schedule appointment for exam
• Perform wellness exam by Medicare guidelines using IMS template
• Assist AWV, CCM, or PCM patient with community resources as needed
• Run report on Medicare/Medicaid patients eligible for CCM/PCM services quarterly
• Contact patients to offer CCM/PCM services
• Facilitate appropriate paperwork for consent for CCM/PCM services
• Utilize templates to document CCM/PCM services
• Contact with CCM/PCM patient via phone/patient portal to discuss care plan, labs, etc.
• Reviewing the current care plan and making changes as needed
• Patient education on disease management upon provider request
• Medication reconciliation
• Hospital follow-up calls and documentation
• Reviewing medical records and test results for AWV, CCM, or PCM patients
• Generate daily huddle reports and distribute to clinical staff
• Generate and work quality reports at least monthly
• Utilize reporting system to generate HBA1C report weekly and contact patients with overdue or HBA1C greater than nine percent
• Assist with WellCare Appointment Agendas
• Contacting other providers regarding patient care  
• Add pop up notes in IMS for care gap services needed
• Other duties as assigned by clinic provider with approval from Chief Nursing Officer

Minimum Qualifications:

• Preferred associate's degree in nursing or higher
• Valid RN license 
• CPR certification
• Experience in medical office setting preferred
• Maintenance of required continuing education courses

Compensation: Negotiable based on experience 
Benefits: Health, Vision, Dental, Life, STD, LTD, 401K, PTO, and Holidays 

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.