Website Borrego Health
Functions as a proactive team member in the integration of whole-person centered health services. Responsible for coordinating the essential components of health services for assigned providers is responsible to be a liaison between the Patient, Primary Care Providers, and specialty Providers as well as community partners. Is responsible for caseload management and patient care coordination, medication review, performing vitals and rooming patients, interpreter services and telehealth monitoring. Assists in the integration of whole-person care with goals toward meaningful data collection and improving the health and well-being of the targeted population. Demonstrates willingness to assist co-workers whenever needed. Maintains good working relationship with all clinic personnel and community partners. Provides compassionate quality care to the patients of Borrego Health.
Essential Duties and Responsibilities:
1. Caseload Management:
a. Actively manages the provider caseload for all assigned providers with the EHR and i2i systems. Adds new patients, closes out patient cases per provider discretion and monitors disengaged patients. Consults with provider to close patient caseloads.
b. If applicable, verifies the Clinician Communication form process for all new intakes is completed by the provider, coordinates with the provider to ensure timely completion.
c. If applicable, verifies that the discharge summaries have been completed by the provider for all discharged patients and discusses with provider for disengaged patients.
d. Verifies that the Coordination of Care form for applicable Health Plans is submitted timely by the provider.
e. Support and closely coordinate health care with the patients Primary Care Provider and all Specialty Provider.
f. Systematically monitors provider caseloads and closely reviews outcome measures of patients and communicates with assigned providers.
g. Consults with the assigned provider for appropriateness and prioritization of patient follow-ups.
h. Systematically outreaches to the patients in between face-to-face appointments and engages them on self-management goals and activities set with the Care Team.
i. Participates as needed in systematic case reviews.
j. Reviews i2i tracks data systematically weekly for patients in the assigned population and discusses as needed with the Provider.
k. Actively monitors and manages the EHR Care Plan and updates as needed per provider updates.
l. Assists patients to follow through in their care plan/wellness goals using both phone and in-person contact.
2. Scheduling: Duties to include:
a. Monitors the schedule for efficient patient workflow and cycle time, assist care team as needed.
b. Monitors “My Day” and the applicable reports in i2i systems, reviews daily in care team huddles as a part of pre-visit planning.
c. Monitor the system throughout the day for patient arrivals with the use of “My Day”
d. Monitor patient compliance with the use of the EHR and i2i systems and reports to Provider.
e. Coordinates transportation request for patients when needed.
f. Coordinate length and frequency of sessions with Provider’s request, patients’ needs and insurance requirements as needed, communicate this to the Customer Service Representatives for scheduling.
3. Medical Records Maintenance duties include:
a. Verify signatures and dates on all forms before scanning into patient’s chart.
b. Assist Provider in completion of standard forms, insurance authorization, letters, SDI, SSI, DOJ, CPS, etc.
c. Monitors provider tags for incoming information regarding medical records i.e. inpatient hospitalization. Notifies all applicable providers (Primary Care, Specialty: Psychiatry, Psychology, HIV/Hep C).
4. Telehealth Monitoring duties include:
a. Verifies procedure approval numbers and authorizations have been documented.
b. Monitors telehealth appointments.
c. Verifies the appropriate scheduling/coordination and use of Telehealth appointment types.
d. Maintain Telehealth documentation in patient medical record.
e. Maintain Telehealth Equipment.
f. Verify patient’s vitals prior to Telehealth appointment.
g. Confirm consents are signed for each Telehealth visit.
5. Interpreter Services:
a. Facilitates cross-cultural communication for non- English-speaking patients of all ages.
b. Communicate with patients to resolve problems and concerns in a courteous, professional and timely manner.
c. Provides all patients with consistent quality service in accordance with Borrego Health Core Values and Standards of Customer Service.
d. Be proactive in communication with patients regarding problems or delays.
e. Maintain accurate demographics and guarantor information at every patient visit.
f. Follow-up with patients which may include making phone calls and document in patients’ health record.
6. Clinical Functions:
a. Coordinates refill prescriptions with the pharmacy, insurance, the provider/s and the patient.
b. Receives and documents patient’s chief complaint, takes vitals, and rooms patient.
c. Medication review.
d. Documents chief complaint, vitals, and all applicable health measures into the EHR (i.e. Viral Load, GAD7, PHQ9, AUDIT, DAST, and Prenatal).
e. Record appropriate cycle time steps within the EHR.
f. Assist patients in monitoring medication refills in a timely manner.
g. Verify that patient has enough medication until next visit.
h. Working with the RN/LVN on Authorization refill.
i. Assist patients with enrollment in pharmaceutical companies’ financial assistance programs environment.
j. Utilizes relationship-based strategies to engage patients in care.
k. Acts as a liaison to create a comprehensive patient centered medical home. Coordinates between insurance companies, community partners, specialty care providers, primary care and patients.
l. Ensures that patients are completing all required health measures in a consistent and timely manner.
m. Provides quality care to patients of Borrego Health, within the scope of practice outlined by state or federal law.
n. Delivers care in accordance with established standard of care and accepted community standards.
o. Understands the organizations commitment to provide high quality integrated patient care.
p. Promotes a patient centered environment.
7. Other duties as assigned
1. Diploma from an approved High school diploma or GED equivalent
2. Medical Assistant certificate
3. Experience: Previous experience in caseload management within the medical field preferred.
4. An understanding of, or ability to learn, insurance and basic medical terminology
5. All staff that is presently working within a clinic is required to have a Current and Valid CPR and First Aide certification on file with the Human Resources Department. This is for clinical and administrative staff. This new license requirement is mandatory for continued employment, CPR and First Aide certification must be obtained through the American Heart Association. Internet certificates do not comply and for this reason are not valid.