Patient Care Coordinator

About Total Care Connect

Total Care Connect (TCC) is a mobile integrated health organization delivering in-home clinical and preventive care to members across Ohio and surrounding regions. We support health plans, health systems, and value-based organizations by reaching members where they are — in their homes and communities — to improve access, close care gaps, and reduce avoidable utilization.

As a tech-enabled, field-based care delivery organization, our teams provide a range of services including preventive care, chronic condition support, transition-of-care visits, member engagement, and navigation. We operate with a focus on high-quality member experience, operational excellence, and coordinated care across clinical, administrative, and remote teams.

Job Summary  

The Patient Care Coordinator supports Total Care Connect’s Mobile Integrated Healthcare (MIH) programs by coordinating referrals, managing patient care workflows, and ensuring seamless communication between healthcare partners, Community Paramedics, and care management teams. 

This role is responsible for processing partner referrals, supporting the coordination of patient visits, and facilitating appropriate follow‑up after care is delivered. Patient Care Coordinators help ensure continuity of care by identifying and relaying care needs, coordinating post‑visit tasks, and distributing visit documentation such as After Visit Summaries (AVS). 

The role also includes assisting with transition‑of‑care calling for other teams when needed to fill calling gaps, ensuring patients receive timely follow‑up during care transitions.

Salary : $50,000 - $60,000
Benefits package: Health, dental, vision insurance; paid time off; 401(k)/retirement; disability

Core Responsibilities  

Referral Management 
• Receive and process patient referrals from healthcare partners 
• Verify referral information for accuracy and completeness 
• Enter and manage referral information within operational systems 
• Coordinate with scheduling teams to ensure timely patient visits 

Care Coordination Support 
• Review Community Paramedic documentation for identified care gaps 
• Communicate identified care needs to partner care management teams 
• Assist with post‑visit patient needs as directed by clinical staff 
• Document and route follow‑up tasks to the appropriate teams 

Post‑Visit Communication 
• Distribute After Visit Summaries (AVS) to healthcare partners 
• Ensure accurate, timely transmission of visit documentation 
• Maintain records of completed communications and referrals 

Patient Account & Care Management 
• Maintain accurate patient records within operational systems 
• Track referral status and visit completion 
• Assist with resolving administrative issues related to patient care or referrals 

Transition‑of‑Care Support 
• Assist with transition‑of‑care calling for other teams when needed 
• Help ensure timely patient follow‑up after hospital discharge or other care transitions 

Operational Support 
• Collaborate with Community Paramedics, scheduling teams, and clinical leadership 
• Escalate issues related to referrals, documentation, or communication 
• Support improvements in referral, communication, and care coordination workflows 

Qualifications  

Required  
• High school diploma or equivalent 
• Experience in healthcare operations, patient coordination, medical office administration, or a related field 
• Strong organizational and communication skills 
• Ability to manage multiple tasks in a fast‑paced environment 

Preferred 
• Experience in care coordination, medical scheduling, or referral management 
• Familiarity with EMR systems or healthcare documentation workflows 
• Experience supporting clinical teams or population health programs 

Core Competencies 

• High attention to detail 
• Clear written and verbal communication 
• Ability to manage multiple workflows simultaneously 
• Professional interaction with healthcare partners 
• Ability to identify and escalate operational issues 
• Comfort working within clinical operations environments 

Work Environment  

The Patient Care Coordinator works closely with Community Paramedics, scheduling teams, and partner care management staff to support coordinated, high‑quality patient care

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