Coordinates and identifies care needs gaps in care for patients attributed to a primary care practice.MISSION VALUES and SERVICE GOALSMISSION We deliver outstanding care inspire health and connect with heart.VALUES Trust. Respect. Integrity. Compassion.SERVICE GOALS Personally connect. Keep everyone informed. Be on their team.ResponsibilitiesIdentifies patients through the health plans gaps in care list state immunization databases the patient medical record and the use of a patient disease management registry.Collaborates with the providers and reviews care needs and validates these needs against the medical record.Reaches out to patients with validated gaps in care and facilitate meeting these needs.Supports quality outcomes and high reliability in the Patient Centered Medical Home.ORGANIZATIONAL RESPONSIBILITIESAssociate complies with the following organizational requirementsAttends and participates in department meetings and is accountable for all information shared.Completes mandatory education annual competencies and department specific education within established timeframes.Completes annual employee health requirements within established timeframes.Maintains licensecertification registration in good standing throughout fiscal year.Direct patient care providers are required to maintain current BCLS CPR and other certifications as required by positiondepartment.Consistently utilizes appropriate universal precautions protective equipment and ergonomic techniques to protect patient and self.Adheres to regulatory agency requirements survey process and compliance.Complies with established organization and department policies.Available to work overtime in addition to working additional or other shifts and schedules when required.Commitment to Beacons six-point Operating System referred to as The Beacon WayLeverage innovation everywhere.Cultivate human talent.Embrace performance improvement.Build greatness through accountability.Use information to improve and advance.Communicate clearly and continuously.EducationHigh School diploma equivalency OR 1 year of applicable cumulative job specific experience required.Note Required professional licensurecertification can be used in lieu of education or experience if applicable.Working ConditionsWorks in an office environment.Physical DemandsRequires the physical ability and stamina i.e. to lift hold carry or transfer items weighing up to 30 pounds etc. to perform the essential functions of the position.