Job description
Travel: 25% Travel throughout our MD Market, Must be located in the DMV, MD Highly Preferred
The Maryland Primary Care Program (MDPCP AHEAD) RN Care Coordinator will work closely with Primary Care providers in the state of Maryland to identify, screen, track, monitor, and coordinate the care of patients with multiple chronic conditions to develop and deliver Comprehensive Primary Care to patients. Our Care Coordinators seek to develop, implement, and deliver extensive care coordination within our medical group and affiliated partners in a patient centered manner. They interact and collaborate with interdisciplinary care teams, population health teams, networked facility partners, physicians, and others involved in meeting the patient’s needs.
Ensure high quality care for patients by reviewing and researching concerns or complaints and recommending corrective action as appropriate.
Identify and recommend solutions to issues and problems.
Maintain excellent communication and effective working relationships with patients, office managers, providers and clinical team members
Collaborate with assigned local teams to meet Maryland Primary Care Program (MDPCP AHEAD) performance metrics
Collaborate effectively with integrated care team to support care coordination for patients
Review patient non-compliance reports and conduct telephonic and/or in person outreach to ensure timely disease specific and wellness visits
Provide Transitional Care Management including, but not limited to, post in-patient and/or emergency department discharge follow up
Provide education and assistance as it relates to lifestyle coaching, dietary improvements and plans
Provide education and assistance in accessing the necessary care outside of the Primary Care Office
Collaborate with providers to review high-risk patients, develop a plan of care, and administer Care Plan to patients
As needed, meet patients in the office or community for face-to-face visits
Provide education and assistance with patient self-management goals
Identify and coordinate referrals to community resources, home care, and disease management programs within Privia Preferred Network
Operate independently within defined practice(s) and patient population to achieve agreed upon goals
Attendance and participation in regular care team meetings to discuss patient care
Perform other duties as assigned
Must have Active RN License
2+ years of population health or care coordination experience
Pediatric experience preferred.
Strong computer and EHR skills and expertise
Preferred experience with Medicaid patients in a value-based program
Preferred experience educating and engaging patients
Experience working in an outpatient medical office
Ability to travel to and from care centers to meet with patients and providers
Must comply with all HIPAA rules and regulations
Bilingual candidates are encouraged to apply (especially those who speak Spanish)
All your information will be kept confidential according to EEO guidelines.
The salary range for this role is $75,000.00 to $85,000.00 in base pay and exclusive of any bonuses or benefits (medical, dental, vision, life, and pet insurance, 401K, paid time off, and other wellness programs). This role is also eligible for an annual bonus targeted at 10%. The base pay offered will be determined based on relevant factors such as experience, education, and geographic location
Technical Requirements (for remote workers only, not applicable for onsite/in office work):
In order to successfully work remotely, supporting our patients and providers, we require a minimum of 5 MBPS for Download Speed and 3 MBPS for the Upload Speed. This should be acquired prior to the start of your employment. The best measure of your internet speed is to use online speed tests like . This gives you an update as to how fast data transfer is with your internet connection and if it meets the minimum speed requirements. Work with your internet provider if you have questions about your connection. Employees who regularly work from home offices are eligible for expense reimbursement to offset this cost.
Privia Health is committed to creating and fostering a work environment that allows and encourages you to bring your whole self to work. We understand that healthcare is local and we are better when our people are a reflection of the communities that we serve. Our goal is to encourage people to pursue all opportunities regardless of their age, color, national origin, physical or mental (dis)ability, race, religion, gender, sex, gender identity and/or expression, marital status, veteran status, or any other characteristic protected by federal, state or local law.
Privia Health™ is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems to optimize physician practices, improve patient experiences, and reward doctors for delivering high-value care in both in-person and virtual settings. The Privia Platform is led by top industry talent and exceptional physician leadership, and consists of scalable operations and end-to-end, cloud-based technology that reduces unnecessary healthcare costs, achieves better outcomes, and improves the health of patients and the well-being of providers.
Originally posted on Himalayas
Who can apply
Eligible countries: United States. Accepted UTC offsets: UTC-10, UTC-9, UTC-8, UTC-7, UTC-6, UTC-5, UTC+14. Review the full description for employer-specific work authorization, residency and schedule requirements.