At Catalyst Physician Group, primary care is redefined! As a physician-owned and physician-led organization, we are dedicated to transforming healthcare by putting patients at the center of everything we do. Our team of over 100 physicians and 500 employees operates across 21 locations in North Texas, providing personalized, accessible care that helps communities thrive.
JOB SUMMARY
The Value-Based Care Coordinator supports primary care clinics by executing standardized workflows that drive value-based care performance across Commercial and Medicare populations. This role focuses on patient outreach, scheduling, care gap closure support, and provider workflow preparation to ensure patients are connected to care and providers are equipped to address quality and risk opportunities during visits.
ROLES AND RESPONSIBILTIES:
Patient Outreach and Scheduling
Conduct targeted outreach to patients to support completion of recommended care including:
Annual Wellness Visits
Preventive screenings (e.g., mammogram, colorectal cancer screening)
Chronic disease follow up (A1C, blood pressure checks)
Prioritize outreach to high-risk, high-opportunity, and care gap populations
Schedule appointments and coordinate folow-up to support timely completion of care
Document outreach and scheduling activities in the EMR
Care Gap Closure Support
Identify patients with open care gaps using available reports and tools
Support closure of care gaps by scheduling required services and coordinating with clinic teams and referral partners
Track completion of recommended services and update systems accordingly
Provider Workflow Preparation (Enablement)
Prepare and ensure availability of tools that support provider performance at the point of care including:
BOI/diagnosis capture forms
Encounter plans and clinical pathway tools
Support pre-visit planning by identifying outstanding care gaps and relevant patient needs
Ensure information is accurate and available to reduce missed opportunities during visits
Quality, Documentation, and Compliance
Execute workflows that support:
Quality measure reporting and submissions (HEDIS / Star)
Attestations / MIPs and required documentation processes
Support provider documentation readiness through standardized workflows (e.g., BOI preparation)
Reconcile labs/imaging, consults, and externa records to ensure information is available for complete and accurate documentation
Care Coordination
Coordinate follow-up care, referrals, and diagnostic testing as needed
Communicate with patients, providers, and clinic staff to support continuity of care
Assist with clinical program enrollment and follow-up activities
Operational Support
Maintain assigned work queues, inboxes, and reports
Follow standardized workflows and escalate issues or barriers as appropriate
Provide cross-coverage for team members as needed
Participate in team meetings and ongoing training
Performance Expectations
Outreach productivity and effectiveness (contact and scheduling rates)
Appointment completion for targeted populations
Support of care gap closure through scheduling and follow-up
Accuracy and timeliness of documentation and workflow execution
Adherence to standardized processses
MINIUMUM QUALIFICATIONS AND REQUIRMENTS:
LVN, Certified Medical Assistant, or equivalent clinical experience required
2-4 years of experience in a clinical or physician office setting
Experience with EMR systems (Athena preferred)
Strong organizational and communication skills
Ability to manage multiple priorities in a fast-aced environment
PREFERRED EXPERIENCE:
Experience in value-based care, quality, HEDIS, or care coordination workflows
Experience with patient outreach and population health initiatives
Familiarity with Medicare and Commercial value-based programs
COMPETITIVE BENEFIT PACKAGE:
Compensation commensurate with experience
Medical, Dental, Vision Insurance
401K with Employer Match
Health Savings Account Options
Paid Holidays and PTO
Referral Programs
Short/Long Term Disability Insurance
At Catalyst, we believe in the power of relationships. Our patient-centric approach ensures that every individual receives comprehensive, connected care at all stages of life. From on-site lab services and telehealth to pediatrics and weight loss programs, we offer a wide range of services to meet diverse healthcare needs.
Join us in our mission to advance health through integrity, honesty, and exceptional patient care. Be a part of a dynamic team that is making a real difference in patient lives across all demographics and health spectrums. Together, we are Catalyst Physician Group - where your career can flourish as you help communities thrive.