DescriptionProject Description: LEAP (Liver Education & Action Program) at Mount Sinai is dedicated to enhancing the diagnosis prevention and treatment of liver diseases in New York City. With a focus on a variety of liver diseases including hepatitis B C and D metabolic-dysfunction associated steatotic liver disease (MASLD formerly fatty liver) and primary biliary cholangitis (PBC). LEAP aims to improve patient outcomes through comprehensive outreach and care coordination addressing both medical and psychosocial needs.
The Care Coordinatorwill provide case management education outreach collaboration and logistical support to patients with liver diseases as they navigate the care and treatment process at Mount Sinai. This is an ideal role for a motivated recent graduate seeking healthcare or public health experience.
This position offers an ideal opportunity to gain experience in community health and healthcare. Previous team members have advanced to pursue further training in medicine nursing and social work or positions in public health health technology and university/hospital administration.
Responsibilities- By phone patient portal letter and potentially bedside reach out to patients who have been recently or previously diagnosed with a liver disease and have not been treated or who need additional diagnostic testing or imaging.
- Schedule appointments accompany patients to appointments when necessary and obtain outside medical records as needed.
- Develop relationships with patients and their caregivers as well as the medical team to promote interdisciplinary communication continuity of care and adherence to patients care plans. Escalate concerns appropriately.
- Collect manage and input clinical and barrier to care data into REDCap database ensuring data security and accuracy. Document encounters in the electronic medical record (EPIC).
- Review patient charts for clinical and research data collection.
- Promote and monitor appointment adherence via meeting patients at appointments follow-up calls and letters.
- Conduct brief screenings and interventions for alcohol substance use and mental health issues.
- Administer pre-treatment readiness assessments to identify and address potential barriers to treatment.
- Provide comprehensive patient education on the natural history of viral hepatitis transmission prevention evaluation treatment options adherence side effect management and general healthy living practices.
- Offer referrals to internal and community resources including primary care providers social services mental health and substance use resources.
- Check in with patients after appointments with liver providers addressing concerns scheduling follow-ups and providing assistance with insurance issues.
- Coordinate with pharmacies insurance companies and providers to prepare prior authorizations for medications as well as ordering delivering and dispensing medications.
- Provide medication adherence counseling and monitor patient-reported side effects via weekly calls reporting to providers as needed.
- Accept and coordinate in-house and outside referrals.
- Follow up on labs ordered by liver providers and review results for evaluation completion.
- Organize and administer program incentives (e.g. metrocards)
- Assist in department research studies by screening subjects for eligibility consenting participants in person coordinating study clinic visits and ensuring IRB requirements are met etc.
- Report to and meet with the Program Manager regularly.
- Attend team meetings contribute case presentations and participate in problem-solving and process improvement discussions.
- Collaborate with community partners to develop and maintain relationships for warm handoffs.
- Perform other duties as assigned.
Qualifications- Bachelors degree in science or related field preferred or a combination of relevant research experience and education. Masters degree preferred ideally in Public Health Social Work Psychology or related field.
- 0-2 years of research/human subjects experience; 1-2 years of experience in community health case management health education or related field preferred
- Fluency in English and Spanish highly desirable; Russian Mandarin Cantonese or French fluency also valued.
- Experience managing databases and summarizing data in tables and charts.
- Knowledge of community resources and healthcare processes and structures.
- Proficiency with personal computers especially Microsoft Office Suite databases and electronic medical records (e.g. EPIC).
- Ability to function at high level remotely (i.e. from home via Zoom etc.) on days not in a clinic setting.
- Strong interpersonal and teamwork skills.
- Excellent oral and written communication skills and attention to detail.
- Strong independent judgment problem-solving skills and ability to thrive in a rapidly evolving environment.
- Eagerness to learn and take on new tasks.
- Must be able to travel to multiple clinics in various locations in New York City Monday - Friday. Currently this role is hybrid on-site and remote. May return to fully on-site/clinic in future.
Required Experience:
IC