Care Team Coordinator (PSCIII)
Massachusetts General Hospital(MGH)

Job Info

The Care Team Coordinator is an essential part of the care team serving as the primary point of contact for patients. The Patient Services Coordinator/Care Team Coordinator (CTC), under general supervision, provides administrative support to healthcare providers in a high-volume ambulatory practice setting. The CTC: Care Team Coordinator works with the Physician Assistant to provide Urologists with the necessary support for their practices. Primary responsibility includes working with Physicians on visit planning for scheduled patients, maintaining calendars, communicating changes in schedules, and assisting with academia and research for respective physicians. Our care teams will "partner" with each patient to define and reach their customized health goals. These health goals will be achieved by providing the patient with superior access to care, information and tools that promote collaboration with their care team and increased self-management of health. The design of the care teams, clinical operations, space and technology will ensure that each staff member is well supported and can effectively use their unique skills as they collaborate to care for patients.

Essential Responsibilities

The CTC will serve as the key interface between the Urology care team and the patient. The CTC will support care team members in all matters related to care coordination and management and will simultaneously serve as a proactive and ready resource for all care coordination needs and inquiries by patients. More specifically:

1. Within the patient visit or other patient interactive processes, the CTC will support the patient and care team in arranging for and coordinating needed patient care services, including but not limited to the following activities:

    • Scheduling visits with specialty consultants or other specialized providers of medical care and research trials.
    • Arranging for tests and other procedures needed by patients.
    • Processing/requesting any necessary insurance referrals or prior approvals related to above services.
    • Documenting and monitoring all required services, and their ultimate completion status, within the "Care Coordination" tracking system. At completion of services, tracking and notification to care team of "urgent care" items.
    • Ongoing and proactive communication with patients and their care team members regarding completed scheduling of services or issues encountered in the care coordination effort.
    • Monitoring of clinical activities to be completed by the patient, including routine screening tests, laboratory, consultant visits, virtual monitoring in the home, return visits to the practice, etc.
    • In regard to vi. above, proactive outreach to patients that are not in compliance with planned care efforts and/or expected timing of such efforts. Related, communication to appropriate care team members when difficulties encountered in securing patient compliance with planned care efforts.
    • Interface with specialty/testing office staff or providers to facilitate urgent or expedited care needs of practice patients, to secure feedback on care provided and care plans, etc.
    • Obtaining pre-visit requirements: orders, outside films, pathology reports, slides, x-rays, x-ray report and lab results, as well as any addition clinical information needed to insure efficiency and accuracy of consultations and second opinions visits.
    • Checking care team schedules in advance to patient's arrivals. While preparing charts. Send out confirmation/reminder letters in advance of appointments

  • With regard to assisting in the successful management and execution of the Urological Care, the CC will:

    • Answering and screens telephone calls coming in from Access Team members and/or patients. Takes accurate message or directs call to appropriate person. Greets and directs patients, families, visitors and staff. Responds to the requests in a timely manner and provides clear, accurate information within scope of knowledge and authority.
    • Document in the electronic medical record, as appropriate, coordination efforts as they pertain to the goals within care team.
    • Monitor patients' demographics and insurance information as necessary and obtain specialist referrals for all patient's appointments. Schedules patient appointments utilizing scheduling tools and resources. Coordinates and communicated ancillary appointments and procedures working with other hospital staff as needed.
    • Assess continuing needs to achieve documented health goals, in collaboration with the care team, and work to address them.
    • Identify key barriers to care and patient's ability to manage their health and wellness.
    • Facilitate access to necessary services by navigating any barriers to care and advocating on the patient's behalf.
    • Act as the liaison by consulting and collaborating with members of the health care team, including the APF care team and outside providers caring for the patient in order to promote continuity of care and attainment of health and wellness goals.
    • Promote wellness and empower the patient to take an active role in the management of their own health.

  • The CTC will maintain the physician's administrative and clinical calendars. Types correspondence, manuscripts, and documents that may require complex formatting. Composes routine correspondence. Transcribes letters and patient notes as needed for physicians and/or facilitates notes and letter in Epic System. Composes routine correspondence. Prepares and distributes material for meeting and committees.

  • The CC will manage preparation for surgical cases, confirm pre-op testing, compile necessary paperwork, and confirm date and time of procedure with patients.

  • 5. The CC will actively participate in daily team huddles and care team meetings to update team members on the care coordination efforts and status thereof, for any patient requiring or requesting services.

    6. In a combined effort with the Care Team, the CC will support care triage as follows:

      • With "high touch - high service" attitude and expertise, effectively manage incoming care need communications from patients and families, whether by phone, care team staff messages or the Patient site In this effort, work effectively to fully investigate, understand and document the patient's needs, concerns and expectations for response, and then communicate back to patients your understanding of patient needs and response expectations, and your next steps toward providing the needed care.
      • With a complete understanding and documentation of patient needs, interface with the patient's team (medical secretary, nurse, APP, MD) to direct messages to those team members that are most appropriate for timely evaluation and response to patient needs. Whenever possible, be proactive in closing the loop with the patient and in supporting the team in whatever way possible.
      • Assist patients with:

        • Completion of practice appointment scheduling
        • Insurance referral processing or questions, referring them to appropriate department
        • Informing practitioners of medication refills
        • Questions regarding lab or other test results
        • Insurance and billing questions
        • Medical forms and record requests
        • Use of technologies created for patient use, i.e. personal health web-site, etc.
        • All other administrative matters

    Follows all scheduling guidelines as defined by MGH Urology management

    • High School diploma required
    • Some college or Associate's Degree preferred
    • 1-2 years of secretarial, customer service experience or equivalent in a medical or healthcare-related setting
    • Preferred: Experience in a clinic, medical or healthcare related setting
    • Knowledge of computer skills necessary to use programs required for day to day clinic operations (Word, Excel, Outlook, internet, MGH electronic health systems, etc)
    • Good verbal and written communication, including the use of medical terminology
    • Exceptional organizational skills, flexibility to manage multiple tasks and the accurate attentive to details
    • Ability to work independently or within a team environment
    • Excellent and effective interpersonal and communication skills
    • Excellent customer service skills
    • Demonstrated ability to work effectively and courteously with various groups of patients, staff and providers.
    • Demonstrated ability to problem solve and function as a resource to other members of the team, and resolve complex issues on behalf of the providers and the patients.
    • Demonstrated in-depth understanding of managed care and all other pertinent insurance/medical coverage
    • Demonstrated knowledge of HIPAA Confidentiality and Privacy Policies
    • Demonstrated understanding of Disaster protocols to include: fire, safety and code calls, per the mandatory training, as outlined by MGH and JCAHO guidelines

    EEO Statement
    Massachusetts General Hospital is an Equal Opportunity Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. Applications from protected veterans and individuals with disabilities are strongly encouraged.

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