- Work in collaboration with multidisciplinary provider team to provide innovative and evidence-based care.
- Participate in practice's collaboration with the Patient Centered Medical Home initiative.
- Use technology to assist with all aspects of care: electronic medical record documentation, disease registry, documentation prompts, standing order protocols.
- Consistently follows all standing orders and advice protocols as a guide in assisting patients.
- Oversees the process of determining the needs of various sets of individuals and creating opportunities for those individuals to achieve optimal health (chronic disease management, wellness promotion, disease prevention, practice population management program) using EHR and registry reporting to determine which patients are overdue for care, services, testing, and/or screening.
- Anticipate the needs of the patient panel, seeing that necessary documentation is completed or requested before patient visit.
- Oversees the preventive care reminder program for the practice's patients, ensuring that patients receive reminders of the need for preventive or disease management screening and testing, including point of care reminders.
- Documents all interactions with patient on the EHR progress note template, including providing the patient with a walk-out Plan of Action after the visit.
- Assist patients in setting SMART goals for self-management, teaching them how to do self-management tasks and report abnormal findings to their physician team.
- Collaborates with the patient, physician, and other care team members in assessing the patient's progress toward individual health care goals.
- Assess barriers when patient has not met treatments goals, is not following treatment plan of care, or has not kept important appointments.
- Lead the physician care teams in ensuring a smooth transition of care for patients treated in a facility (inpatient or emergency department), by a specialty physicians, or by another health care provider.
- Assists in setting up the shared medical appointment program for the practice and participates in patient shared medical appointments as requested.
- Develops a community resource list of services available to patients and maintains collegial relationships with community resource agencies used most frequently.
- Involves patients in activities to improve their health( patient engagement).
- Educates panel patients about health preserving, disease prevention, and disease self-management interventions, creating a collaborative relationship with the patient in the management of their health care status;
Refers patients to other entities for education and support (Diabetes Education Program, as needed).
- Assist patient with procurement of medical supplies need to care for themselves when necessary.
- Contacts patient between visits via telephone, email, other to check on self-monitoring, provide encouragement and support, and assess patient progress toward health status goals.
- Assists patient care teams with pre-visit preparation.
- Orders and arranges for testing and treatment for patients as provided in the Delegation of Clinical Responsibilities Policy (Standing Orders).
- Oversees the development, procurement, and adoption of patient self-management educational resources used by the practice providers.
- Participates in the process of incorporating evidenced based diagnosis and treatment guidelines into the care processes in the practice.
- Assist, as requested, with triage of urgent matters that occur over the phone and when patients walk-in.
- Assist with all aspects of the patient's care: referrals to specialists, hospitalizations, ancillary testing, and other enabling services.
- May perform other duties as assigned.
High School diploma/GED plus one (1) year of direct patient care experience required. Must be a graduate of an accredited medical assisting program.
Knowledge, Skills & Abilities:
- Good communication skills, Computer/basic keyboard skills, telephone etiquette skills, and general knowledge of office machines including printers and scanners.
- Excellent customer service skills.
- Knowledge in basic medical terminology required.
This position is subject to a pre-employment criminal background check and drug screen. A criminal conviction or arrest pending adjudication alone shall not disqualify an applicant except as provided by law. Any criminal history will be evaluated in relationship to job responsibilities and business necessity. The information obtained in these reports will be used in a confidential, non-discriminatory manner consistent with state and federal law.
UAMS is an Affirmative Action and Equal Opportunity Employer of individuals with disabilities and protected veterans and is committed to excellence.
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