Strength through Unity and Inclusion

The Mount Sinai Health System is committed to fostering an environment where everyone can contribute to excellence. We share a common dedication to delivering outstanding patient care. When you join us, you become part of Mount Sinai’s unparalleled legacy of achievement, education, and innovation as we work together to transform healthcare. We encourage all team members to actively participate in creating a culture that ensures fair access to opportunities, promotes inclusive practices, and supports the success of every individual.

At Mount Sinai, our leaders are committed to fostering a workplace where all employees feel valued, respected, and empowered to grow. We strive to create an environment where collaboration, fairness, and continuous learning drive positive change, improving the well-being of our staff, patients, and organization. Our leaders are expected to challenge outdated practices, promote a culture of respect, and work toward meaningful improvements that enhance patient care and workplace experiences. We are dedicated to building a supportive and welcoming environment where everyone has the opportunity to thrive and advance professionally. Explore this opportunity and be part of the next chapter in our history.

About the Mount Sinai Health System

Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 48,000 employees working across eight hospitals, more than 400 outpatient practices, more than 300 labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time — discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it.

Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients’ medical and emotional needs at the center of all treatment. The Health System includes more than 9,000 primary and specialty care physicians; 13 joint-venture outpatient surgery centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and more than 30 affiliated community health centers.

We are consistently ranked by U.S. News & World Report's Best Hospitals, receiving high "Honor Roll" status, and are highly ranked: No. 1 in Geriatrics, top 5 in Cardiology/Heart Surgery, and top 20 in Diabetes/Endocrinology, Gastroenterology/GI Surgery, Neurology/Neurosurgery, Orthopedics, Pulmonology/Lung Surgery, Rehabilitation, and Urology. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 12 in Ophthalmology. U.S. News & World Report’s “Best Children’s Hospitals” ranks Mount Sinai Kravis Children's Hospital among the country’s best in several pediatric specialties.

The Icahn School of Medicine at Mount Sinai is ranked No. 11 nationwide in National Institutes of Health funding and in the 99th percentile in research dollars per investigator according to the Association of American Medical Colleges. Newsweek’s “The World’s Best Smart Hospitals” ranks The Mount Sinai Hospital as No. 1 in New York and in the top five globally, and Mount Sinai Morningside in the top 20 globally.

Equal Opportunity Employer

The Mount Sinai Health System is an equal opportunity employer, complying with all applicable federal civil rights laws. We do not discriminate, exclude, or treat individuals differently based on race, color, national origin, age, religion, disability, sex, sexual orientation, gender, veteran status, or any other characteristic protected by law. We are deeply committed to fostering an environment where all faculty, staff, students, trainees, patients, visitors, and the communities we serve feel respected and supported. Our goal is to create a healthcare and learning institution that actively works to remove barriers, address challenges, and promote fairness in all aspects of our organization.

The Program Coordinator supports the delivery of high-quality, patient-centered care by proactively identifying and engaging patients with outstanding preventive care and chronic disease management needs.

Working in collaboration with physicians, advanced practice providers, nursing, practice operations, and other members of the care team, the Program Coordinator conducts outreach to patients based on provider recommendations and identified quality care gaps. The Coordinator facilitates completion of recommended screenings, laboratory testing, examinations, and follow-up care.

The role serves as an important link between patients and the clinical team, helping patients navigate recommended services, addressing barriers to completion, and ensuring appropriate documentation and follow-up. The Program Coordinator contributes directly to organizational quality goals, population health initiatives, and improved patient outcomes.

Patient Outreach & Care Coordination

Conduct proactive outreach to patients identified by physicians, clinical teams, quality reports, registries, or population health worklists as having outstanding preventive or condition-specific care needs.
Educate patients regarding the importance of completing physician-recommended screenings, laboratory testing, examinations, and follow-up appointments using approved patient education and communication materials.
Assist patients with scheduling appropriate appointments, diagnostic testing, laboratory services, or specialty services.
Provide patients with appropriate scheduling instructions and contact information when direct scheduling is not available.
Conduct follow-up outreach when recommended services have not been completed.
Identify barriers that may prevent patients from completing recommended care and escalate issues to the appropriate clinical or operational team when additional intervention is required.
Document all patient outreach, responses, scheduled services, refusals, barriers, and other relevant information accurately and timely in the electronic health record or designated population health platform.
Route clinical questions or concerns to the appropriate licensed clinical team member and remain within the defined scope of the position.

Quality & Care Gap Management

Support outreach and care coordination for quality measures and preventive/chronic disease care gaps, including but not limited to:
Breast cancer screening/mammography
Colorectal cancer screening/colonoscopy and other approved screening modalities
Diabetes monitoring, including HbA1c testing
Blood pressure monitoring and follow-up for patients with hypertension
Depression screening and appropriate clinical follow-up workflows
Diabetic eye examinations
Kidney health evaluation for patients with diabetes
Statin therapy and related follow-up for eligible patients
Other preventive health, chronic disease, and quality measures identified by the organization, payer programs, or clinical leadership
The Coordinator does not independently determine clinical eligibility, recommend treatment, interpret results, or modify a patient's care plan. Outreach is conducted according to established clinical protocols, quality criteria, and/or physician or care-team recommendations.

Program Worklist Management

Maintain assigned patient registries, work queues, outreach lists, and quality dashboards.
Prioritize outreach based on organizational goals, clinical guidance, due dates, and identified care gaps.
Review available records to determine whether recommended services may have already been completed internally or externally before contacting the patient.
Assist with obtaining outside records when patients report that screenings, examinations, or testing were completed outside the health system.
Facilitate appropriate documentation of externally completed services so that patient records and quality reporting accurately reflect completed care.
Track patients through the outreach process from initial identification through completion, documented refusal, clinical exclusion, or appropriate escalation.
Maintain accurate disposition of assigned care gaps and outreach activity.

Patient Engagement

Use patient-centered communication techniques to encourage participation in preventive and chronic disease care.
Explain the purpose of outreach clearly while reinforcing that recommendations originate from the patient's physician, care team, or established clinical protocols.
Provide courteous and culturally sensitive service while maintaining patient confidentiality.
Recognize when a patient requires additional clinical guidance and appropriately escalate to nursing or the provider.
Support patients experiencing non-clinical barriers to completing care by connecting them with available resources or the appropriate department.

Quality Improvement & Reporting

Support departmental initiatives designed to improve preventive screening rates, chronic disease management, and overall quality performance.
Monitor assigned outreach activity and completion rates.
Identify recurring barriers, workflow issues, or trends affecting patients' ability to complete recommended care.
Communicate trends and operational concerns to practice and program leadership.
Participate in quality improvement initiatives, outreach campaigns, and focused interventions for populations with identified care gaps.
Assist leadership with reports related to outreach volume, patient engagement, scheduled services, completed services, outstanding care gaps, and other population health metrics.

Performance Expectations

Performance may be evaluated using measures such as:
Number of patients successfully contacted
Outreach completion rate
Percentage of identified care gaps addressed
Screening/test scheduling conversion
Completion rate following outreach
Accuracy and timeliness of documentation
Reduction in outstanding care gaps
Appropriate escalation of clinical concerns
Patient engagement and service quality
Performance expectations should account for patient eligibility, inability to contact patients, patient refusal, clinical exclusions, and other factors outside of the Coordinator's control.
Bachelor's Degree or an equivalent combination of education and/or experience may substitute for the degree when the experiences are closely related to the duties of the job.
None required, but 1-2 years administrative experience preferred

Experience

Prior experience in an ambulatory medical practice, population health program, patient access center, care coordination, medical office, or healthcare environment preferred.
Experience conducting patient outreach or scheduling healthcare services strongly preferred.
Experience working with electronic health records, preferably Epic, and patient work queues preferred.

Knowledge, Skills & Abilities

Strong verbal communication and patient engagement skills.
Ability to communicate effectively with patients from diverse backgrounds.
Strong organizational and follow-up skills.
Ability to manage a high-volume patient outreach worklist.
Attention to detail and commitment to accurate documentation.
Ability to understand and follow standardized clinical and operational workflows.
Ability to identify issues requiring clinical escalation without providing clinical advice outside the scope of the role.
Working knowledge of preventive health and chronic disease quality measures preferred.
Proficiency with electronic health records, Microsoft Office, and related healthcare technology.
Ability to work collaboratively with physicians, APPs, nurses, medical assistants, scheduling teams, and practice leadership.
Knowledge of HIPAA and patient confidentiality requirements.

Compensation Statement

The Mount Sinai Health System (MSHS) provides salary ranges that comply with the New York City Law on Salary Transparency in Job Advertisements. The salary range for the role is $66,482.07 - $75,000.00 Annually. Actual salaries depend on a variety of factors, including experience, education, and operational need. The salary range or contractual rate listed does not include bonuses/incentive, differential pay or other forms of compensation or benefits.

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