Medical
2 days ago
**Care Coordination & Patient Support**
- Schedule patient visits, diagnostic tests, and clinician referrals.
- Coordinate telehealth consultations or homebased services as needed.
- Ensure patients complete necessary screenings and assessments as per assigned clinical pathways.
**Clinical Data Management**
- Track patient Lab results & vitals, including blood pressure, blood glucose, weight, and height.
- Analyze trends and escalate abnormal findings to BCC clinicians.
- Ensure accurate and timely documentation in electronic health records & program specific systems
**Patient Education & Engagement**
- Educate patients on chronic disease management, medication adherence, and lifestyle changes.
- Provide guidance on remote patient monitoring devices and self-care strategies.
- Address patient concerns and provide support as needed
**Interdisciplinary Collaboration**
- Act as a bridge between medical teams to ensure coordinated care.
- Relay test results, treatment updates, and clinician recommendations to patients.
- Participate in case discussions and contribute to care planning.
**Quality & Compliance**
- Document patient progress and treatment adherence.
- Identify gaps in care and propose solutions to improve patient outcomes.
- Support data collection for quality improvement initiatives and program evaluation.
**Skills**:
- Bachelor’s degree in Nursing, Health Sciences, Health Coach, or a related field.
- Experience in chronic disease management, care coordination, or patient advocacy.
- Strong communication and interpersonal skills.
- Proficiency in using electronic health records (EHR) and remote monitoring tools.
- Ability to interpret medical data and escalate concerns appropriately.
- Knowledge of healthcare regulations and chronic disease management guidelines.
**Education**:
Nurse or Health Education or Medical Laboratory
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