Physician Enterprise - Practice Solutions Jobs

Position Objective:

The Community Health Worker (CHW) position is responsible for acting as a bridge between health care providers, community services providers, and individuals in the community to promote health, reduce disparities, and improve service delivery. The Community Health Worker is a trained and trusted public health worker who is respected by the people they serve and applies his/her unique understanding of the experience, socio-economic needs, language and/or culture of the communities served. CHWs identify barriers to health and advocate for changing service delivery and other strategies to improve community health.

Essential Job Duties:

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions

1. Refers and links patients to a medical home for preventive health care, provides age appropriate screenings, self-management education, and chronic conditions social service support.
2. Assists patients in navigating the health system and links patients to community resources to meet basic needs that influence health (i.e. housing, food, job placement, legal representation, education)
3. Collaborates  with the care team and providers to conduct outreach, enroll patients in programs and coordinate their care needs, being considerate of their cultural practices and beliefs
4. Engage and collaborate with Patients to set goals by implementing motivational interviewing techniques.
5. Adhere to performance productivity standards to meet department goals.

Educational/Experience Requirements:

• High School diploma or equivalent.
• One (1) year or more of experience preferred
• Must be self-directed and have strong verbal and oral communication skills

Required License/Certifications:

• None

Working Conditions, Equipment, Physical Demands:

There is a reasonable expectation that employees in this position will be exposed to blood-borne pathogens.

Physical Demands –  

The physical demands and work environment that have been described are representative of those an employee encounters while performing the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions in accordance with the Americans with Disabilities Act.

The above job description is an overview of the functions and requirements for this position.  This document is not intended to be an exhaustive list encompassing every duty and requirement of this position; your supervisor may assign other duties as deemed necessary.

Position Objective:

To efficiently and effectively triage incoming calls and provide a variety of nursing treatment functions, including assessment of symptoms, prioritizing patient appointments, facilitating smooth patient flow and by providing assistance to both physician and clinical support staff within the office..

Essential Job Duties:

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions

1. Obtains patient vital signs and prepares patients for examination by physician
2. Review and update beneficiary’s medical and family history
3. Develop personalized patient prevention plan
4. Complete Assessments like Health Risk, Social Determinants of Health, Functional Assessments, and others as applicable.
5. Review and update medication list, specialists, and applicable durable medical equipment
6. Assist with prevention measure like health screenings and HEIDS measures
7. Update lab, vaccinations, orders, and referrals as needed
8. Develop health advice and referrals to health education or prevention counseling services or programs
9. Communicates with patients regarding their medical questions, medication inquiries, etc. Handles follow-up/Post-Op calls to patients.
10. Assists physician with in-office procedures as needed.

Educational/Experience Requirements:

The minimum level of education and experience for this position includes:

• High School diploma, GED or equivalent
• Must complete accredited LPN program.

Required License/Certifications: 

• Must adhere to the credentialing requirements of AAMC as stated in the nursing bylaws.
• Cardiopulmonary Resuscitation
• Licensed Practical Nurse

Working Conditions, Equipment, Physical Demands:

There is a reasonable expectation that employees in this position will be exposed to blood-borne pathogens.

Physical Demands -

The physical demands and work environment that have been described are representative of those an employee encounters while performing the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions in accordance with the Americans with Disabilities Act.

Luminis Health

Title:  Registered Nurse-MDPCP 

Position Objective: 

To efficiently and effectively provide patient triage and a variety of nursing treatment functions including but not limited to; assessment of symptoms, prioritizing patient appointments, determining patient disposition, and providing feedback to provider.

Essential Job Duties: 

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions 

1. The Triage Nurse assures that communication with each caller will be handled in a professional and tactful manner
2. Communicates with patients regarding their medical questions, medication inquiries, etc.
3. Handles follow-up calls to patients per provider request.
4. Triage incoming patient calls regarding medical concerns and determine appropriate disposition (schedule appointment, Urgent Care, ER).  
5. When appropriate, the caller’s symptoms will be assessed and triaged using the nursing process and approved guidelines to assist in obtaining the appropriate level of care and/or self-care advice
6. Provide patient education in alignment with treatment goal(s).
7. Advise patients on health maintenance and disease prevention 
8. Monitor provider in basket to assist the provider in patient intervention and/or forwarding message to the provider for additional clinical guidance.
9. Debrief/communicate with provider as needed.
10. Document all patient-provider-staff communication in EPIC.
11. Communicates with insurance companies to obtain required authorizations, if applicable.
12. Maintain accurate, detailed reports and records
13. Participate and oversee performance and quality improvement activities
14. Work collaboratively with RN Care Managers, LPNs and Medical Assistants in support of clinical providers and patients’ needs

Educational/Experience Requirements: 

• Graduate of an accredited School of Nursing.   
• Two years of related clinical nursing experience. 

Required License/Certifications:   

• Current Maryland Board of Nursing license. 
• CPR through the American Heart Association (BLS for Healthcare Providers level). 

Working Conditions, Equipment, Physical Demands: 

There is a reasonable expectation that employees in this position will be exposed to blood-borne pathogens.  

Physical Demands –  

Medium Work 

The physical demands and work environment that have been described are representative of those an employee encounters while performing the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions in accordance with the Americans with Disabilities Act. 

The above job description is an overview of the functions and requirements for this position.  This document is not intended to be an exhaustive list encompassing every duty and requirement of this position; your supervisor may assign other duties as deemed necessary.

Updated: 2.5.24

Position Objective:

Advanced Medical Assistant

The Advanced Medical Assistant is an essential part of the Advanced Primary Care Team and facilitates meeting the goals of the Maryland Primary Care Program and Value Based Contracts.  Their main responsibilities are to coordinate patient care, provide patient outreach and education and identify barriers that may affect the patient from meeting his/her treatment goals. The Advanced Medical Assistant will perform a variety of administrative and clinical tasks to support the provider/practice to ensure the patient receives the right care at the right time and right place to decrease hospital re-admission and unnecessary utilization of Emergency Room and/or Urgent Care. The Advanced Medical Assistant maintains knowledge of care coordination/management, behavioral health resources, CRISP Portal/Reports, Value Based Contract Portals, EPIC Registries and patient self-management tools/resources.
Essential Job Duties:

1. Monitor and validate patient attribution to the practice and the care teams within the practice (known as empanelment).
2. Ensure patients identified as increased risk receive targeted, proactive, relationship-based (longitudinal) care coordination and/or care management.
3. Pre-visit planning workflow for Annual Wellness Visits scheduled with the LPN Team and/or practice provider.
4. Provide patient education and resources to engage the patient in his/her treatment plan and improve their overall health.
5. Actively manages assigned panel of to develop relationship with patient as an integral member of team, provide follow-up contact with patient as indicated to ensure compliance with recommendations medications, lab/x-ray, specialist visits, PCP visits, dieticians, CDE, etc.
6. Maintains access to all Value Based Payor portals for attestation of metrics and/or to pull appropriate care gap and utilization reports.
7. Provides patient outreach for TCM/ED visits within required timeframe, i.e. within 48 hours inpatient discharge; within 7 days emergency room discharge.  The Advanced Medical Assistant will schedule a follow up appointment with the patients primary care provider or Advanced Internal Medicine.
8. Assist patients in setting SMART goals for self -management, teaching them how to do self-management tasks and report abnormal findings to their provider team;
9. Assess barriers when patient has not met treatments goals, is not following treatment plan of care, or has not kept important appointments; refers patient to the Community Care Management Team (RN, LCSW, CHW) for intervention.
10. Identify patient social and behavioral health needs, consult with clinician, as appropriate provide warm hand off to Ambulatory Care Management, social work, care navigation, and behavioral health services.
11. Collaborate with providers, and other frequently used healthcare resources to develop effective timely communication between the patients care teams; and in assessing the patients progress toward individual health care goals
12. Oversees the development, procurement, and adoption of patient self-management educational resources used by the primary clinical teams.
13. Ensure targeted patients who have received follow-up after ED, hospital discharge, or other triggering events receive short-term (episodic) care management if applicable.
14. Contribute to a positive experience for patients and families through courteous telephone interactions and interview activities, accurate and expeditious routing, as well as referral to appropriate clinical staff when necessary.
15. Recognize and report data inconsistencies to appropriate practice personnel, and facilitate appropriate data capture and reporting methodologies
16. Contribute to teamwork within and between departments. Regularly participate in meetings as deemed appropriate by leadership.  
17. Provide and receive constructive ideas, suggestions and feedback in a positive manner. Work collaboratively with co-workers to effectively resolve issues that impact departmental operations.
18. Monitor and collaborate with practice to improve performance on key outcomes, including cost of care, electronic clinical quality measures, beneficiary experience, and utilization measures.

Educational/Experience Requirements:

The minimum level of education and experience for this position includes:

• Minimum of High School Diploma
• Completion of accredited medical assistant training program preferred.
• Three years of experience as a Medical Assistant
• Experience with Microsoft Office and Excel.
• Strong customer service skills
• Basic math skills.

Required License/Certifications: 

• CMA, RMA or AAMA (through an approved/accredited organization). Must maintain Certification or credentials while employed required within 6 months of hire.
• CPR Certified

Working Conditions, Equipment, Physical Demands:

There is a reasonable expectation that employees in this position will be exposed to blood-borne pathogens.

Physical Demands –Light Work

The physical demands and work environment that have been described are representative of those an employee encounters while performing the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions in accordance with the Americans with Disabilities Act.

The above job description is an overview of the functions and requirements for this position.  This document is not intended to be an exhaustive list encompassing every duty and requirement of this position; your supervisor may assign other duties as deemed necessary

Updated: 2.5.24

Position Objective:

Advanced Medical Assistant

The Advanced Medical Assistant is an essential part of the Advanced Primary Care Team and facilitates meeting the goals of the Maryland Primary Care Program and Value Based Contracts.  Their main responsibilities are to coordinate patient care, provide patient outreach and education and identify barriers that may affect the patient from meeting his/her treatment goals. The Advanced Medical Assistant will perform a variety of administrative and clinical tasks to support the provider/practice to ensure the patient receives the right care at the right time and right place to decrease hospital re-admission and unnecessary utilization of Emergency Room and/or Urgent Care. The Advanced Medical Assistant maintains knowledge of care coordination/management, behavioral health resources, CRISP Portal/Reports, Value Based Contract Portals, EPIC Registries and patient self-management tools/resources.
Essential Job Duties:

1. Monitor and validate patient attribution to the practice and the care teams within the practice (known as empanelment).
2. Ensure patients identified as increased risk receive targeted, proactive, relationship-based (longitudinal) care coordination and/or care management.
3. Pre-visit planning workflow for Annual Wellness Visits scheduled with the LPN Team and/or practice provider.
4. Provide patient education and resources to engage the patient in his/her treatment plan and improve their overall health.
5. Actively manages assigned panel of to develop relationship with patient as an integral member of team, provide follow-up contact with patient as indicated to ensure compliance with recommendations medications, lab/x-ray, specialist visits, PCP visits, dieticians, CDE, etc.
6. Maintains access to all Value Based Payor portals for attestation of metrics and/or to pull appropriate care gap and utilization reports.
7. Provides patient outreach for TCM/ED visits within required timeframe, i.e. within 48 hours inpatient discharge; within 7 days emergency room discharge.  The Advanced Medical Assistant will schedule a follow up appointment with the patients primary care provider or Advanced Internal Medicine.
8. Assist patients in setting SMART goals for self -management, teaching them how to do self-management tasks and report abnormal findings to their provider team;
9. Assess barriers when patient has not met treatments goals, is not following treatment plan of care, or has not kept important appointments; refers patient to the Community Care Management Team (RN, LCSW, CHW) for intervention.
10. Identify patient social and behavioral health needs, consult with clinician, as appropriate provide warm hand off to Ambulatory Care Management, social work, care navigation, and behavioral health services.
11. Collaborate with providers, and other frequently used healthcare resources to develop effective timely communication between the patients care teams; and in assessing the patients progress toward individual health care goals
12. Oversees the development, procurement, and adoption of patient self-management educational resources used by the primary clinical teams.
13. Ensure targeted patients who have received follow-up after ED, hospital discharge, or other triggering events receive short-term (episodic) care management if applicable.
14. Contribute to a positive experience for patients and families through courteous telephone interactions and interview activities, accurate and expeditious routing, as well as referral to appropriate clinical staff when necessary.
15. Recognize and report data inconsistencies to appropriate practice personnel, and facilitate appropriate data capture and reporting methodologies
16. Contribute to teamwork within and between departments. Regularly participate in meetings as deemed appropriate by leadership.  
17. Provide and receive constructive ideas, suggestions and feedback in a positive manner. Work collaboratively with co-workers to effectively resolve issues that impact departmental operations.
18. Monitor and collaborate with practice to improve performance on key outcomes, including cost of care, electronic clinical quality measures, beneficiary experience, and utilization measures.

Educational/Experience Requirements:

The minimum level of education and experience for this position includes:

• Minimum of High School Diploma
• Completion of accredited medical assistant training program preferred.
• Three years of experience as a Medical Assistant
• Experience with Microsoft Office and Excel.
• Strong customer service skills
• Basic math skills.

Required License/Certifications: 

• CMA, RMA or AAMA (through an approved/accredited organization). Must maintain Certification or credentials while employed required within 6 months of hire.
• CPR Certified

Working Conditions, Equipment, Physical Demands:

There is a reasonable expectation that employees in this position will be exposed to blood-borne pathogens.

Physical Demands –Light Work

The physical demands and work environment that have been described are representative of those an employee encounters while performing the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions in accordance with the Americans with Disabilities Act.

The above job description is an overview of the functions and requirements for this position.  This document is not intended to be an exhaustive list encompassing every duty and requirement of this position; your supervisor may assign other duties as deemed necessary

Updated: 2.5.24

Position Objective:

Advanced Medical Assistant

The Advanced Medical Assistant is an essential part of the Advanced Primary Care Team and facilitates meeting the goals of the Maryland Primary Care Program and Value Based Contracts.  Their main responsibilities are to coordinate patient care, provide patient outreach and education and identify barriers that may affect the patient from meeting his/her treatment goals. The Advanced Medical Assistant will perform a variety of administrative and clinical tasks to support the provider/practice to ensure the patient receives the right care at the right time and right place to decrease hospital re-admission and unnecessary utilization of Emergency Room and/or Urgent Care. The Advanced Medical Assistant maintains knowledge of care coordination/management, behavioral health resources, CRISP Portal/Reports, Value Based Contract Portals, EPIC Registries and patient self-management tools/resources.
Essential Job Duties:

1. Monitor and validate patient attribution to the practice and the care teams within the practice (known as empanelment).
2. Ensure patients identified as increased risk receive targeted, proactive, relationship-based (longitudinal) care coordination and/or care management.
3. Pre-visit planning workflow for Annual Wellness Visits scheduled with the LPN Team and/or practice provider.
4. Provide patient education and resources to engage the patient in his/her treatment plan and improve their overall health.
5. Actively manages assigned panel of to develop relationship with patient as an integral member of team, provide follow-up contact with patient as indicated to ensure compliance with recommendations medications, lab/x-ray, specialist visits, PCP visits, dieticians, CDE, etc.
6. Maintains access to all Value Based Payor portals for attestation of metrics and/or to pull appropriate care gap and utilization reports.
7. Provides patient outreach for TCM/ED visits within required timeframe, i.e. within 48 hours inpatient discharge; within 7 days emergency room discharge.  The Advanced Medical Assistant will schedule a follow up appointment with the patients primary care provider or Advanced Internal Medicine.
8. Assist patients in setting SMART goals for self -management, teaching them how to do self-management tasks and report abnormal findings to their provider team;
9. Assess barriers when patient has not met treatments goals, is not following treatment plan of care, or has not kept important appointments; refers patient to the Community Care Management Team (RN, LCSW, CHW) for intervention.
10. Identify patient social and behavioral health needs, consult with clinician, as appropriate provide warm hand off to Ambulatory Care Management, social work, care navigation, and behavioral health services.
11. Collaborate with providers, and other frequently used healthcare resources to develop effective timely communication between the patients care teams; and in assessing the patients progress toward individual health care goals
12. Oversees the development, procurement, and adoption of patient self-management educational resources used by the primary clinical teams.
13. Ensure targeted patients who have received follow-up after ED, hospital discharge, or other triggering events receive short-term (episodic) care management if applicable.
14. Contribute to a positive experience for patients and families through courteous telephone interactions and interview activities, accurate and expeditious routing, as well as referral to appropriate clinical staff when necessary.
15. Recognize and report data inconsistencies to appropriate practice personnel, and facilitate appropriate data capture and reporting methodologies
16. Contribute to teamwork within and between departments. Regularly participate in meetings as deemed appropriate by leadership.  
17. Provide and receive constructive ideas, suggestions and feedback in a positive manner. Work collaboratively with co-workers to effectively resolve issues that impact departmental operations.
18. Monitor and collaborate with practice to improve performance on key outcomes, including cost of care, electronic clinical quality measures, beneficiary experience, and utilization measures.

Educational/Experience Requirements:

The minimum level of education and experience for this position includes:

• Minimum of High School Diploma
• Completion of accredited medical assistant training program preferred.
• Three years of experience as a Medical Assistant
• Experience with Microsoft Office and Excel.
• Strong customer service skills
• Basic math skills.

Required License/Certifications: 

• CMA, RMA or AAMA (through an approved/accredited organization). Must maintain Certification or credentials while employed required within 6 months of hire.
• CPR Certified

Working Conditions, Equipment, Physical Demands:

There is a reasonable expectation that employees in this position will be exposed to blood-borne pathogens.

Physical Demands –Light Work

The physical demands and work environment that have been described are representative of those an employee encounters while performing the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions in accordance with the Americans with Disabilities Act.

The above job description is an overview of the functions and requirements for this position.  This document is not intended to be an exhaustive list encompassing every duty and requirement of this position; your supervisor may assign other duties as deemed necessary

Updated: 2.5.24