I. General Summary

Works in collaboration with the practice manager, physicians, advanced practice providers, office staff, and other members of the practice team to foster interdisciplinary planning and collaborative relationships to meet quality metrics, review gaps in care, help patients navigate the healthcare system, screen for social determinants of health, and manage clinical conditions in the community with identified resources. Serves as a clinical resource for the office staff and supports the team with care coordination.

II. Principal Responsibilities and Tasks

The following statements are intended to describe the general nature and level of work being performed by people assigned to this classification. They are not to be construed as an exhaustive list of all job duties performed by personnel so classified.

1. In collaboration with the providers, assists with patient advice calls, patient triage assessments, managing clinical boxes, and coordinating EPIC My Portfolio Medical Advice messages.
2. In collaboration with the providers, completes pre and post procedural calls with patients providing them instructions and their caregivers.
3. In collaboration with the practice manager, assists the staff with pre-visit planning to complete tasks associated with closing gaps in care and meeting quality measures.
4. Serves as a clinical resource/educator to facilitate the development of the team in collaboration with the providers, practice manager, clinical leads, and care manager.
5. Reviews quality measures with the Director of the Medical Group, Program Consultant, and Director of Operations.
6. Reviews quality measures with the providers and office staff and collaboratively works to develop initiatives to improve or maintain those measures.
7. In collaboration with the practice manager, assists with staff training and the creation of standard work.
8. Ensures consistent application of medical group rules and regulations.
9. Participates in the development and implementation of practice guidelines, procedures, and standards. Including documentation and follow-up.
10. Supports the team with care coordination.
11. Performs related duties as assigned.