CARE COORDINATOR- AUMS

Who You’ll Join At Santiam Hospital & Clinics , we believe exceptional patient care starts with a supportive and inclusive work environment. We empower every team member by providing access to advanced medical technology and continuous professional development. Join our collaborative culture, where your contributions are valued and your growth is encouraged. The Care Coordinator plays a vital role in advancing Santiam Hospital & Clinics’ mission to deliver compassionate, coordinated, and high-quality care to every patient. This position is full-time, Monday – Friday, 8:00 PM – 4:30 PM, and is based in our Aumsville Medical Clinic location. As the Care Coordinator at our Aumsville Medical Clinic , you will help patients navigate their healthcare journey by identifying needs, closing care gaps, coordinating follow-up services, and connecting patients with the resources they need to achieve better health outcomes. As a Care Coordinator you will build relationships and work closely with providers, clinic staff, and community partners, to support quality initiatives, and help create a seamless, patient-centered care experience. The ideal candidate is a proactive, detail-oriented, compassionate healthcare professional who thrives in a team-based clinic environment and is motivated by helping patients overcome barriers to care. Candidates who are energized by problem-solving, collaboration, quality improvement, and making a meaningful difference in the health of the community will excel in this role. Come take the next step in your healthcare career - apply today and bring your expertise to Santiam Hospital & Clinics , recently honored as 2025’s Best Hospital in the Willamette Valley! What You’ll Do Determine and document patient care needs and preferences, disseminate such information to internal and external healthcare team members, facilitate communication between members, and organize care activity in manner that facilitates delivery of high-quality patient care that is safe, appropriate, and cost-effective. Care Gap Management Analyze patient HIMS records to make complete lists of data missing from each record (i.e. “scrub chart”), and list care gaps for data categories that may include diagnostic imaging studies, health maintenance needs, laboratory tests, vaccinations, and other classifications. When indicated, discuss identified gaps with patients. Order, coordinate, or facilitate scheduling for appointments, studies, or other means to close gaps. After patient discharge from an emergency department or hospital, review discharge summaries, accordingly, update HIMS records, coordinate indicated follow-up care, schedule indicated provider appointments, complete care transition documentation, and contact patient to ensure that discharge instructions are obeyed and appropriate care is delivered. Assist patients who suffer from chronic diseases that require care in excess of routine Clinic visits by coordinating indicated education, referral, durable medical equipment, home health service, and scheduled communications; by providing or assisting with follow-up to ensure that patients follow provider recommendations; and by facilitating adjustments to care plan as is appropriate. Identify patients who have complex healthcare needs and manage such patients in manner that ensures receipt of indicated follow-up and services. In absence of Community Health Worker involvement, coordinate patient services and referrals that are urgently needed through use of applicable social service platforms (e.g. “Unite Us”). Assist with identifying patient needs for Clinic physical examination appointments (e.g. Medicare Annual Wellness Visits), and help to prepare for appointments by preordering and facilitating order of studies or tests that accord with applicable protocols. Collaborate with Medical Assistants and other Clinic staff to ensure that delivered healthcare quality is sufficient to meet or exceed designated quality benchmarks and initiatives. Populate patient HIMS records with applicable insurance metrics and surveil pertinent payor portals to confirm Clinic compliance with payor reporting requirements. Perform other duties assigned by Medical Clinic Manager or Medical Clinic Supervisor.