Clinical Services Coordinator

Are you ready to join a passionate community of people who are changing how health care is delivered?  A place where you will find a career you love while truly making a difference building healthier communities.  If this sounds like you, we would love to have you apply as Clinical Services Coordinator, with Medical Home Network!

Since 2009, Medical Home Network (MHN) has partnered with Federally Qualified Health Centers (FQHCs) nationwide to transform care in the safety net, reduce health disparities, and build healthier communities. A mission-driven public benefit corporation, MHN helps FQHCs succeed in value-based care through technology, care model innovation, and strong partnerships. Our proven approach delivers leading health outcomes, lower costs, and elevated quality performance. We’re expanding our reach and impact to help more FQHCs enhance care for their patients. Modern Healthcare has named MHN one of the Best Places to Work in Healthcare for four years running (2021–2024). MHN was recently recognized as a Great Place to Work in 2026.

THE OPPORTUNITY:

The Clinical Services Coordinator serves as a key member of the clinical operations team, supporting patients, providers, and care teams through patient outreach, care coordination, scheduling, preventive care initiatives, and transitional care activities. This role is responsible for contacting and engaging patients across multiple population health programs, including Annual Wellness Visits (AWVs), Timely Follow-Up/Transitions of Care (TOC), preventive screenings, and other value-based care initiatives This role will also work closely with internal teams to assist in any required patient contact.

The Clinical Services Coordinator partners closely with interdisciplinary care teams to improve patient access, coordinate services, close care gaps, and ensure timely follow-up. This position leverages technology-enabled tools, AI, electronic medical records, and population health reports to identify outreach opportunities, support quality initiatives, and enhance the patient experience. 

THE PERKS:

• Fun, challenging, and collaborative work environment with passionate colleagues that care deeply about healthcare delivery.
• Recognized as One of the Best Places to Work in Healthcare by Modern Healthcare.
• Competitive benefits programs including Medical, Vision, Dental, HSA, FSA, and 401k.
• Fitness reimbursement, commuter benefits, and tuition assistance.
• Great work life benefits- Paid time off, sick time, and 12 paid holidays.
• Fully Remote Schedule: Must be available to work during standard business hours of 8:00 AM–5:00 PM Central Time (CT).

WHAT YOU CAN LOOK FORWARD TO:

Patient Outreach, Scheduling, Screenings & Care Coordination  

• Conduct proactive patient outreach to support clinical initiatives  
• Schedule, request medical records, and connect patients with services across primary care, specialty care, behavioral health, and community-based organizations 
• Build collaborative relationships with patients, caregivers, clinical staff, and community organizations 
• Provide patient education, reinforce care plans, and support self-management activities 
• Assist patients in navigating healthcare services, insurance resources, transportation, and other community resources 
• Conduct timely outreach following emergency department visits, hospital admissions, and other care transitions to support continuity of care 
• Appropriately Identify and escalate clinical, behavioral health, or social concerns 
• Coordinate post-discharge appointments, medication reconciliation or review, referrals, and additional follow-up activities as directed.  
• Support Annual Wellness Visit workflows, scheduling preventative care, and other types of appointments  
• Complete screenings and assessments with patients, including health risk assessments, PHQ-9s and social determinants of health (SDOH) screenings and others as appropriate 
• Collaborate with Care Transformation Partners to support health centers’ needs and participate in influencing how to improve patient engagement to meet goals  

 

Clinical Workflow & Best Practices 

• Support standardized workflows and best practices across clinical service lines and new clinical programs 
• Assist with onboarding, training, and sharing best practices with team members as needed 
• Contribute to optimizing and documenting workflows to establish standards of care, best practices, and policies 
• Ability to adapt to changing priorities and flexibly supporting multiple clinical programs as needed. 

 

Documentation and Compliance 

• Maintain accurate, timely, and complete documentation within the EMR and care management platforms.  
• Comply with organizational policies, regulatory requirements, privacy standards, and documentation guidelines.  
• Support technology-enabled outreach platforms, and other digital solutions which may enhance workflow or patient engagement 

WHAT YOU’LL NEED TO SUCCEED:

• 3 years of work experience in care coordination, patient outreach, and connecting patients to community resources  
• Bilingual in Spanish and fluent in medical terminology 
• Experience in one or more of the following settings: 
• • Safety-net or public health hospitals 
  • • Federally Qualified Health Centers (FQHCs) 
    • • Academic medical centers 
      • • Ambulatory care 
        • • Physician groups or professional practices 
          • • Community Mental Health Centers 
            • • Substance use treatment settings 
              • • Outpatient mental health services 
                • Proficient in Microsoft Office 

                 

                PREFERRED:

                • Experience in engaging patients with chronic illnesses and needs related to behavioral health and multiple social factors affecting health outcomes.  
                • Knowledge and experience working with Medicaid and Medicare populations and in value-based care desirable.