TCM Coordinator

JOB SUMMARY:

The TCM Coordinator plays a vital role in ensuring safe, timely, and coordinated transitions of care from hospital to home or other care settings. This position is responsible for managing and coordinating all post-discharge activities, including patient follow-up, medication reconciliation and communication between patients and care teams.

JOB DUTIES:

JOB REQUIREMENTS

Key Responsibilities:

• Review daily cases for admissions and discharges for inpatient stays and ER visits
• Conduct post-discharge follow-up calls within 24–48 hours to review medications and report and concerns to clinic nurse
• Schedule TCM appointment with PCP within 5 days of discharge
• Identify and escalate any clinical concerns or red flags to the appropriate care provider or clinic nurse
• Collaborate with care teams for continuity of care
• Access hospital portals to track admissions and retrieve discharge summaries and diagnostic results
• Document all patient interactions and follow-ups in the electronic health record (EHR) in a timely and accurate manner
• Assist with quality improvement initiatives related to discharge processes and readmission reduction
• Maintain up-to-date knowledge of discharge protocols, transitional care workflows, and healthcare resources

Education and/or Experience

Qualifications:

Required:

• Medical Assistant or related experience
• Understanding of medical terminology
• At least 3 years of experience in a clinical setting
• Familiarity with EHR systems (e.g., eCW, Epic, Cerner)

Preferred:

• Experience with care coordination and chart reviews
• Strong communication and patient education skills

Skills & Abilities:

• Excellent interpersonal and organizational skills
• Ability to multitask and manage time effectively in a fast-paced environment
• Ability to navigate through multiple electronic systems simultaneously
• Empathy, patience, and a patient-centered approach
• Strong attention to detail and follow-through
• Ability to work independently and as part of a multidisciplinary team

WORK ENVIRONMENT

All work is performed within a standard health care/primary care clinical setting.

DISCLAIMER

The duties and responsibilities, qualifications, physical conditions, and other statements contained herein represent the current general nature of the job described, and are subject to change at any time, with or without notice. This job description does not limit in any way the assignments that may be given to an employee in the job, and employees are expected to perform all duties assigned by their supervisor willingly and without reservation.

Job Type: Full-time

Pay: $16.50 - $19.50 per hour

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Health insurance
• Health savings account
• Life insurance
• Paid time off
• Parental leave
• Professional development assistance
• Referral program
• Tuition reimbursement
• Vision insurance

Application Question(s):

• How many years of Medical Assistant experience do you have?
• Do you have a valid Certified Medical Assistant Certificate?
• Do you have experience working with EHR systems (eCW, Epic, Athena)?
• Have you ever worked for Aegis Medical Group and/or Lakeview Healthcare System?

Experience:

• clinical setting: 3 years (Required)

Language:

• Spanish (Preferred)

Work Location: In person