Eventus WholeHealth
Care Coordinator Lead
– Eventus WholeHealth Position Summary:
The Care Coordination Team Lead ensures patient navigation is implemented by managing Care Coordinators and their client caseloads, training Care Coordinators in coordinating primary and specialty care, coordinating transitions of care, and collaborating closely with patient schedulers for timely follow‑up appointments. The Lead also assists the Care Coordination Manager by training new hires, editing and approving time cards, covering team members on PTO, and supporting duties when the Director of Care Coordination is unavailable.
Essential Duties and Responsibilities
Client caseload management (own small caseload and cover team members on PTO).
Provide critical insights and valuable data to support care for patients with chronic conditions.
Communicate with patient families/POAs/caregivers post‑visit to provide clinical updates and answer questions.
Support care delivery by ensuring labs, specialty notes, hospital and SNF records are available in the EHR.
Review patients’ medical histories from all internal and external sources.
Perform medication reconciliation after transitions of care and summary of SNF/hospital stays.
Create and update CCM and BHI care plans, ensuring adherence to recommendations and proper therapies.
Refer patients to needed services, including specialist referrals.
Call patients/POAs/caregivers within 48 hours after discharge to schedule follow‑up visits.
Facilitate discussions with health‑care providers on care plans, medication reconciliation, family input, and referrals.
Document client services in the chart and track appointments confidentially.
Initiate outreach and missed‑appointment procedures as necessary.
Coordinate physician visits and scheduling for ACO reach patients within one week after transition of care.
Track time spent in care coordination for chronic care management minutes.
Ensure Medicare requirements of CCM and BHI programs are met.
Lead and train care coordination team members, providing support and training.
Approve or edit timecards for other team members.
Complete five audits per team member monthly.
Assist with referrals, medical records, and immediate needs for team members on PTO.
Education and/or Certifications
LPN degree or experienced certified MA with at least 5 years in primary care.
Minimum 1 year experience with Eventus.
Minimum 2 years in LTC/ALF settings.
Care coordination experience preferred.
Value‑based care experience ideal.
Strong understanding of cultural competency with the target population.
Competency with Excel, PCC, Matrix, and Microsoft products.
Interest in working with geriatric clients.
Skills and Qualifications
Commitment to the mission of care coordination.
Excellent communication and interpersonal skills; able to communicate concisely with diverse audiences.
Strong knowledge of the geriatric population and patient navigation.
Organized with confidential client material, appointment tracking, and caseloads.
Desire to build relationships with patients, families, and the healthcare team.
Strong organizational and time‑management skills; able to prioritize tasks and meet deadlines.
Professional verbal and written communication skills across phone, email, and written correspondence.
Friendly and professional demeanor.
Compliance Requirements
Adherence to all federal, state, and local laws, regulations, standards, guidelines, and Eventus WholeHealth policies and procedures.
Stay informed of any changes that impact the job and the company.
Promptly report non‑compliant conduct or practices to the Chief Compliance and Risk Officer.
Ensure adherence to the Code of Ethics and Business Conduct.
Protect patient information per federal and state privacy laws and company policies.
Maintain accurate and complete documentation.
Participate in and complete all assigned training by deadlines.
Engage in regular risk assessments and report incidents to the Chief Compliance and Risk Officer.
Physical Requirements
Communicate with others, including in stressful or high‑pressure environments.
Move around the office to access files and resources; sit or remain stationary for extended periods for computer and phone use.
Stand or access high places as occasionally required.
Operate computers, phones, and other office equipment consistently.
Bend, stoop, kneel, or crouch as required.
Work Environment
Low to moderate noise levels typical of office settings.
Collaborative environment with need to manage conflict and handle stressful situations.
Desk work in an office setting.
Flexible hours as needed to meet patient care demands.
Consistent with applicable federal and state laws, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job.
Seniority Level Mid‑Senior level
Employment type Full-time
Job function Other
Industries Hospitals and Health Care
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– Eventus WholeHealth Position Summary:
The Care Coordination Team Lead ensures patient navigation is implemented by managing Care Coordinators and their client caseloads, training Care Coordinators in coordinating primary and specialty care, coordinating transitions of care, and collaborating closely with patient schedulers for timely follow‑up appointments. The Lead also assists the Care Coordination Manager by training new hires, editing and approving time cards, covering team members on PTO, and supporting duties when the Director of Care Coordination is unavailable.
Essential Duties and Responsibilities
Client caseload management (own small caseload and cover team members on PTO).
Provide critical insights and valuable data to support care for patients with chronic conditions.
Communicate with patient families/POAs/caregivers post‑visit to provide clinical updates and answer questions.
Support care delivery by ensuring labs, specialty notes, hospital and SNF records are available in the EHR.
Review patients’ medical histories from all internal and external sources.
Perform medication reconciliation after transitions of care and summary of SNF/hospital stays.
Create and update CCM and BHI care plans, ensuring adherence to recommendations and proper therapies.
Refer patients to needed services, including specialist referrals.
Call patients/POAs/caregivers within 48 hours after discharge to schedule follow‑up visits.
Facilitate discussions with health‑care providers on care plans, medication reconciliation, family input, and referrals.
Document client services in the chart and track appointments confidentially.
Initiate outreach and missed‑appointment procedures as necessary.
Coordinate physician visits and scheduling for ACO reach patients within one week after transition of care.
Track time spent in care coordination for chronic care management minutes.
Ensure Medicare requirements of CCM and BHI programs are met.
Lead and train care coordination team members, providing support and training.
Approve or edit timecards for other team members.
Complete five audits per team member monthly.
Assist with referrals, medical records, and immediate needs for team members on PTO.
Education and/or Certifications
LPN degree or experienced certified MA with at least 5 years in primary care.
Minimum 1 year experience with Eventus.
Minimum 2 years in LTC/ALF settings.
Care coordination experience preferred.
Value‑based care experience ideal.
Strong understanding of cultural competency with the target population.
Competency with Excel, PCC, Matrix, and Microsoft products.
Interest in working with geriatric clients.
Skills and Qualifications
Commitment to the mission of care coordination.
Excellent communication and interpersonal skills; able to communicate concisely with diverse audiences.
Strong knowledge of the geriatric population and patient navigation.
Organized with confidential client material, appointment tracking, and caseloads.
Desire to build relationships with patients, families, and the healthcare team.
Strong organizational and time‑management skills; able to prioritize tasks and meet deadlines.
Professional verbal and written communication skills across phone, email, and written correspondence.
Friendly and professional demeanor.
Compliance Requirements
Adherence to all federal, state, and local laws, regulations, standards, guidelines, and Eventus WholeHealth policies and procedures.
Stay informed of any changes that impact the job and the company.
Promptly report non‑compliant conduct or practices to the Chief Compliance and Risk Officer.
Ensure adherence to the Code of Ethics and Business Conduct.
Protect patient information per federal and state privacy laws and company policies.
Maintain accurate and complete documentation.
Participate in and complete all assigned training by deadlines.
Engage in regular risk assessments and report incidents to the Chief Compliance and Risk Officer.
Physical Requirements
Communicate with others, including in stressful or high‑pressure environments.
Move around the office to access files and resources; sit or remain stationary for extended periods for computer and phone use.
Stand or access high places as occasionally required.
Operate computers, phones, and other office equipment consistently.
Bend, stoop, kneel, or crouch as required.
Work Environment
Low to moderate noise levels typical of office settings.
Collaborative environment with need to manage conflict and handle stressful situations.
Desk work in an office setting.
Flexible hours as needed to meet patient care demands.
Consistent with applicable federal and state laws, reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the job.
Seniority Level Mid‑Senior level
Employment type Full-time
Job function Other
Industries Hospitals and Health Care
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