Req#: 565495
Clinica Sierra Vista is excited to be one of the largest Federally Qualified Health Centers in the Nation! We’re honored to serve the men and women of the fields. We also offer care and support to the inner city, the rural and isolated, those of low, moderate, and fixed incomes, and families from an array of cultural backgrounds who speak several languages. We don’t inquire about immigration status because we simply don’t need to know. If you come to us, we will treat you like any other patient.

As we grow our team, we are looking for individuals who believe the patient is always #1.

Why work for us?

• Competitive pay which matches your abilities and experience
• Health coverage for you and your family
• Generous number of vacation days per year
• A robust wellness plan and health club discounts
• Continuing education assistance to grow and further your talents
• 403(B) plan with company matching

Intrigued? We’d love to hear from you! Please review the job details below and then click “apply.”

We're looking for someone to join our team as an Care Coordinator - ECM who:

The Care Coordinator ECM serves as the point of contact for members enrolled Enhanced Care Management (ECM) program. This role is responsible for coordinating care, connecting members with community resources, assisting with medical referrals, and ensuring continuity of care. The Care Coordinator works collaboratively with providers, case managers, and interdisciplinary teams to support patient needs and improve health outcomes.




Essential Functions:

1. Meet with all new patients to explain the ECM program, its benefits, and available resources.
2. Complete the New Enrollment Assessment for all new members
3. Serve as the main contact for members, maintaining active engagement and ensuring monthly encounters.
4. Ensure follow-ups for all referrals, including both medical and community-based services.
5. Maintain and update care plans based on members' social determinants of health.
6. Assist members with social determinant needs by connecting them with community resources (e.g., housing, food assistance, transportation).
7. Complete and maintain accurate documentation, including assessment flowsheets and goal progression updates.
8. Track patient status changes (e.g., transfers, disenrollments, deaths) and update records accordingly.
9. Update goal progression for members enrolled in the ECM program.
10. Provide regular updates to case managers regarding assigned member’s progress.
11. Participate in Interdisciplinary Care Team (ICT) meetings to support patient-centered care planning.
12. Resolves unassigned patients by reviewing appointment history (and possibly the clinical record) to determine appropriate assignment.
13. Work with site-based teams to ensure appropriate coordination of services for members.
14. Communicate with external providers to ensure seamless continuity of care.
15. Engage high-priority patients to promote expanded access to care and reduce unnecessary emergency room utilization.
16. Run, manage, and analyze standard Clinica Sierra Vista (CSV) reports related to patient panels and clinical quality metrics.
17. Oversee and analyze panel data related to CSV-priority conditions using CSV’s reporting systems and Excel.
18. Ensure clinic-wide compliance with CSV, PCMH, CMS, Meaningful Use and California Department of Public Health (CDPH) requirements.
19. Support clinic-wide initiatives to meet or improve clinical quality goals




You'll be successful with the following qualifications:

• Education: Medical Assistant certification or program completion preferred.
• Computer proficiency: Excel, Word, Outlook, PDF, Electronic Health Records, etc.
• Bilingual (Spanish/English) preferred.
• Maintain excellent internal and external customer service at all times.
• Maintain the highest degree of confidentiality possible when performing the functions of this department.
• Possess the tact necessary to deal effectively with patients, providers, and employees, while maintaining confidentiality.
• Must be able to work independently, handling high volume and multiple tasks.
• Must be reliable with attendance.
• Must be highly organized and detail oriented.
• Possess knowledge of modern office equipment, systems and procedures.
• Ability to multi-task and work efficiently in a potentially stressful environment.
• Ability to apply common sense understanding when carrying out detailed written or oral instructions.
• Must have excellent verbal and written communication skills.
• Ability to effectively present information and respond to questions from internal and external customers.
• Must have a pleasant, professional attitude toward patients, providers, co-workers and superiors.
• Teamwork skills a must.
• Must adhere to Clinica Sierra Vista’s employee health/immunization requirements or provide a valid exemption request for subsequent approval.

• Must adhere to Clinica Sierra Vista’s employee health/immunization requirements or provide a valid exemption request for subsequent approval.
  
  

Clinica Sierra Vista values human rights, goodwill, respect, inclusivity, equality, and recognizes that the organization derives its strength from a rich diversity of thoughts, ideas, and contributions. As leaders in healthcare industry, we aspire to be an employer of choice by promoting an organizational culture that reflects these core values. We seek to attract, develop, and retain a talented and dedicated workforce where people of diverse races, genders, religions, cultures, political affiliations and lifestyles thrive. Our goal is to create a welcoming and inclusive environment that empowers our employees to provide the highest level of service to our community of residents and businesses; they’re counting on us.

Clinica Sierra Vista is an equal opportunity employer and strives to attract qualified applicants from all walks of life without regard to race, color, ethnicity, religion, national origin, age, sex, sexual orientation, gender identity, gender expression, marital status, ancestry, physical disability, mental disability, medical condition, genetic information, military and veteran status, or any other status protected under federal, state and/or local law. We aim to create an environment that celebrates and embraces the diversity of our workforce. We welcome you to join our team!