Care Coordinator, Family Medicine- AZ - Multispecialty Clinic

Job Category: Staff

Requisition Number: CAREC
004181

Apply now

• Posted :
  October 1, 2025
• Full-Time

Showing 1 location

Arizona MS Clinic
Glendale, AZ 85308, USA

Summary

The Care Coordinator is primarily responsible for coordinating the chronic care management program within the Family Medicine Clinic. The Family Medicine Clinic is implementing a new program that provides patients services related to chronic care management, wellness visits, and managing patient panels for Medicare Advantage and Medicaid plans. The Care Coordinator will ensure patients are properly educated on the program, obtain consent, and track time spent each month managing chronic conditions.

The position reports directly to the Manager of Patient Accounts.

• Conduct outreach to eligible Family Medicine Clinic patients, educating them on the chronic care management program, and ensuring patients understand and are aware of the cost sharing components associated with the program.
• Gather and document verbal or written consent from patients that are enrolled in the program.
• Conduct monthly follow-up calls with enrolled patients, document, and track calls accordingly.
• Collaborate with Family Medicine Clinic providers to create a comprehensive care plan for each enrolled patient in the program.
• Coordinate patient’s prescriptions ensuring they are in line with their comprehensive care plan.
• Schedule successive routine appointments between patients and the same assigned provider from the clinic care team, to ensure continuity of care.
• Coordinate care transition following ER visits, inpatient, or Skilled Nursing Facility (SNF) admission for patients and schedule primary care follow up appointments.
• Manage insurance dashboards for quality measures including scheduling wellness visits and assisting with quality measure follow up.
• Facilitate regular communication between patients and other members from the Family Medicine Clinic.
• Review monthly billing, ensuring that only one practitioner is charging the patient for services each month.
• Coordinate the Medicare reimbursement process for Chronic Care Management, and review billing codes to ensure correct codes are being used.
• Enter orders for labs, radiology studies, referrals as assigned.
• Facilitate the offboarding process for patients that opt out of the program.

Qualifications

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. This individual must have the ability to work in a constant state of alertness and safe manner and must have regular, predictable, in-person attendance. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and/or Experience

High School Diploma or GED is required. Must have at least 5 years of healthcare related work experience. Prior Medical Assistant or LPN experience preferred. Familiarity with Chronic Care Management highly desired. The ideal candidate will have excellent time management skills, exceptional customer service, and the ability to establish and maintain effective working relationships with patients, providers, and clinic staff.

Excellent written/oral communications skills, the ability to manage multiple priorities, and knowledge of medical terminology are essential.

Computer Skills

Computer proficiency in MS Office (Word, Excel, Outlook, PowerPoint). Familiarity with EHRs software desired.

Physical Demands

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is frequently required to sit, talk and hear. The employee must regularly use hands to handle or feel and reach with hands and arms. The employee is required to stand and walk for long periods of time. The employee must frequently lift and /or move up…