Care Coordinator, Tennessee



Memphis, TN, USA
Posted on Thursday, February 1, 2024
Aledade is now hiring a Care Coordinator who will work alongside HealthChoice primary care practices onsite. This individual will collaborate with the care team within each practice, leveraging Aledade’s interdisciplinary care team (Aledade Care Solutions of A+, Aleade’s patient facing arm) to coordinate care. The Care Coordinator will use Aledade’s proprietary population health tool for outreach to high-risk patients, using real-time data to identify and intervene on high utilizers who could benefit from more preventive and active management. This role will work closely with Medicare patients to support them in becoming active in their health care by better understanding their conditions, helping them access care in the most appropriate care setting, and improving quality of care.

Primary Duties:

  • Conduct direct telephonic outreach to prioritized patients on the provided worklists within the Aledade app.
  • Follow standard messaging provided by Aledade while following the highest standard of customer service to assist patients in setting up an appointment with the patient’s primary care provider (PCP).
  • Apply motivational interviewing tactics to break down psychosocial barriers to scheduling appointments while keeping the patients’ best interests in mind.
  • Act as a liaison for the patient and practice by directing calls to other appropriate individuals or departments within the practice as needed
  • Track outreach and outcome documentation in the Aledade App and/or in a shared Google Drive document or other tracking system provided by Aledade.
  • Identify outreach trends and report back findings to the team, share creative ideas for increasing patient visits

Minimum Qualifications:

  • Current MA or LPN licensed
  • 3-5 years of direct healthcare experience, preferably in home health, ambulatory care, community public health, case management, or care coordination across multiple settings and with multiple providers
  • 1+ years of experience with EHRs
  • Located in an area that allows flexibility to travel in the Memphis area 3-4 days a week
  • Have experience with MSSP and medicare advantage contracts - quality and gaps in care

Preferred Qualifications:

  • Understanding of MSSP and MA quality metrics
  • Ability to apply clinical knowledge and motivational interviewing skills to address the patient's chronic disease, psychosocial, behavioral health, hospital utilization, pharmaceutical, and social determinants of health barriers
  • Experience with Epic and eCW
  • Demonstrated ability to work in a fast-paced, ever-changing environment
  • Resourcefulness and intuition; ability to work independently with a strong attention to detail
Who We Are:
Aledade, a public benefit corporation, exists to empower the most transformational part of our health care landscape - independent primary care. We were founded in 2014, and since then, we've become the largest network of independent primary care in the country - helping practices, health centers and clinics deliver better care to their patients and thrive in value-based care. Additionally, by creating value-based contracts across a wide variety of payers, we aim to flip the script on the traditional fee-for-service model. Our work strengthens continuity of care, aligns incentives, and ensures primary care physicians are paid for what they do best - keeping patients healthy. If you want to help create a health care system that is good for patients, good for practices and good for society - and if you're eager to join a collaborative, inclusive and remote-first culture - you've come to the right place.
What Does This Mean for You?
At Aledade, you will be part of a creative culture that is driven by a passion for tackling complex issues with respect, open-mindedness and a desire to learn. You will collaborate with team members who bring a wide range of experiences, interests, backgrounds, beliefs and achievements to their work - and who are all united by a shared passion for public health and a commitment to the Aledade mission.
In addition to time off to support work-life balance and enjoyment, we offer the following comprehensive benefits package designed for the overall well-being of our team members:
Flexible work schedules and the ability to work remotely are available for many roles
Health, dental and vision insurance paid up to 80% for employees, dependents, and domestic partners Robust time off plan 21 days of PTO in your first year 2 Paid Volunteer Days & 11 paid holidays
12 weeks paid Parental Leave for all new parents
6 weeks paid sabbatical after 6 years of service
Educational Assistant Program & Clinical Employee Reimbursement Program
401(K) with up to 4% match
Stock options
And much more!
At Aledade, we don’t just accept differences, we celebrate them! We strive to attract, develop, and retain highly qualified individuals representing the diverse communities where we live and work. Aledade is committed to creating a diverse environment and is proud to be an equal opportunity employer. Employment policies and decisions at Aledade are based on merit, qualifications, performance, and business needs. All qualified candidates will receive consideration for employment without regard to age, race, color, national origin, gender (including pregnancy, childbirth or medical conditions related to pregnancy or childbirth), gender identity or expression, religion, physical or mental disability, medical condition, legally protected genetic information, marital status, veteran status, or sexual orientation.
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