Community Clinic Inc.·Silver Spring, Maryland
The Clinical Care Coordinator manages patient panels to improve health outcomes and close care gaps by coordinating interventions for complex chronic needs. They serve as a liaison between patients and care management resources while maintaining accurate documentation in electronic health records.
Population Health at CCI speaks to the systematic process of utilizing data on patient populations to design targeted interventions for better health outcomes at lower cost, resulting in a better care experience. As part of the Population Health team, the Clinical Care Coordinator is responsible for managing the member panel to assist the member in reaching desired patient outcomes and care gap closures, coordinating specific care interventions for patients with identified complex chronic care needs. This position serves as a liaison between the patient's needs and the resources provided by the care management program.
Panel Monitoring
Utilizes CipherHealth PHIP and ED/IP programs, daily in response to calls that appear on the program dashboard.
Monitor the next day's scheduled CipherHealth calls, daily.
Download the PPMCO 360 Report on the 3rd Friday of each month from the JHHP SFTP site.
Completes and updates the Outreach Outcomes Report, as needed.
Update supervisor of any issues accessing the member panel
Member Outreach
Make outreach calls using Outreach Call Scripts within the prescribed timetable: First call within 24 hours of the request, 2nd call 2-3 days, 3rd call 7-10 days.
Schedule appointments following CCI Scheduling Guidelines/Workflows.
Assist with rescheduling and canceling appointments.
Assists with transportation arrangements for eligible members
Coordinates with IT to utilize the Outreach Call Scripts for mass communication during Special Outreach Campaigns.
Document all member interactions in the medical record utilizing the Electronic Health Record.
Monitor Appointment Attendance
Monitor upcoming appointment dates.
Confirm appointment attendance and document outcomes in the panel, daily.
Member Engagement
Coordinate follow-up care plans by scheduling needed appointments or enrolling members in related programs.
Identify any barriers and coordinate resolution to ensure members receive appropriate care, at the proper level, in a timely manner.
Ask follow-up questions and listen actively to identify patient questions or issues while documenting required information in computer systems.
Investigate inquiries, provide necessary follow-up, and document actions required to service the inquiry.
Proper and professional grooming is always expected.
Prolonged periods of standing, bending or working at a desk on a computer.
The ability to lift (up to 15lbs) is required.
Work under stressful conditions within a controlled enclosed environment daily. The work environment involves exposure to potentially dangerous materials and situations that require extensive safety precautions and may include the use of protective equipment.
ADA Category. In accordance with the American with Disabilities Act, it is possible that requirements may be modified to reasonably accommodate disabled individuals. However, no accommodation will be made which may pose serious health or safety risks to the employee or others or which impose undue hardships on the organization.
OSHA Category 1. Clinical environment. Possibility of exposure to chemicals and infectious body fluids e.g., HPV, HIV, HEP C, HSV.
The position requires an associate degree, with a bachelor's degree preferred. Candidates must be capable of working in a clinical environment and performing tasks such as data collection, patient outreach, and appointment management.
Market context
Clinical Care Coordinator roles in Maryland are often driven by ongoing demand for organized patient support, outreach, and appointment management in clinical settings. These positions are competitive because employers typically look for candidates who can combine patient communication, data collection, and care coordination, with an associate degree required and a bachelor’s degree preferred. Review the AI-summarized requirements and benefits here to save research time, then tailor your application to show experience with clinical workflows and patient follow-up.