GENERAL SUMMARY

Schedule: Full Time, Monday-Friday

Location: Detroit, MI-hybrid position with meetings in offices around Detroit

Position Summary

The Care Coordination & Quality Specialist plays a key role in improving patient outcomes by identifying and addressing gaps in care for patients attributed to a primary care practice. This position works collaboratively with providers, care teams, and patients to support preventive care, chronic disease management, quality performance initiatives, and Patient-Centered Medical Home (PCMH) standards. The ideal candidate is highly organized, detail-oriented, and skilled in using healthcare technology and Microsoft Office applications to drive quality improvement and practice transformation efforts.

• Identify and monitor patient care needs and gaps in care using health plan reports, state immunization registries, electronic medical records (EMR), and disease management registries.
• Collaborate with providers and clinical staff to review, validate, and prioritize identified care gaps based on clinical documentation and patient history.
• Conduct proactive outreach to patients by phone, electronic communication, or other approved methods to facilitate completion of recommended preventive, chronic care, and wellness services.
• Coordinate care activities and connect patients with appropriate resources to ensure timely closure of identified care gaps.
• Support quality improvement initiatives by tracking performance metrics and contributing to strategies that improve clinical outcomes and patient engagement.
• Promote and support high-reliability practices and quality outcomes within the Patient-Centered Medical Home (PCMH) model.
• Utilize Microsoft Office applications and healthcare information systems to analyze data, maintain accurate records, generate reports, and monitor quality measures.
• Participate in practice improvement and transformation activities designed to enhance patient care, operational efficiency, and value-based care performance.
• Maintain compliance with organizational policies, regulatory requirements, and quality program standards.

Schedule: Full Time, Monday-Friday. Location: Detroit, MI-hybrid position with meetings in offices around Detroit. Position Summary. The Care Coordination & Quality Specialist plays a key role in improving patient outcomes by identifying and addressing gaps in care for patients attributed to a primary care practice. This position works collaboratively with providers, care teams, and patients to support preventive care, chronic disease management, quality performance initiatives, and Patient-Centered Medical Home (PCMH) standards. The ideal candidate is highly organized, detail-oriented, and skilled in using healthcare technology and Microsoft Office applications to drive quality improvement and practice transformation efforts. Key Responsibilities. Identify and monitor patient care needs and gaps in care using health plan reports, state immunization registries, electronic medical records (EMR), and disease management registries. Collaborate with providers and clinical staff to review, validate, and prioritize identified care gaps based on clinical documentation and patient history. Conduct proactive outreach to patients by phone, electronic communication, or other approved methods to facilitate completion of recommended preventive, chronic care, and wellness services. Coordinate care activities and connect patients with appropriate resources to ensure timely closure of identified care gaps. Support quality improvement initiatives by tracking performance metrics and contributing to strategies that improve clinical outcomes and patient engagement. Promote and support high-reliability practices and quality outcomes within the Patient-Centered Medical Home (PCMH) model. Utilize Microsoft Office applications and healthcare information systems to analyze data, maintain accurate records, generate reports, and monitor quality measures. Participate in practice improvement and transformation activities designed to enhance patient care, operational efficiency, and value-based care performance. Maintain compliance with organizational policies, regulatory requirements, and quality program standards. CERTIFICATIONS/ LICENSURES REQUIRED: Current BLS-C upon hire or successful completion by end of orientation. EDUCATION/ EXPERIENCE REQUIRED: High school diploma or G.E.D. equivalent. Population health experience preferred. Ambulatory practice support, HEDIS/gap closure, and EHR documentation workflow experience preferred. Microsoft 365 experience needed Additional Information Organization: Henry Ford Ascension Medical Group MI Department: Population Health Shift: Day Job Union Code: Not Applicable

search terms: Coordinator+Health