Gainesville, FL, Provider Liaison- Medical Assistant Temporary

Medical Assistant (Temporary Position)

Theoria Medical is a physician-led post-acute care organization delivering value-based care in the skilled nursing facility (SNF) setting. Instead of asking patients to come to us, we bring high-quality, patient-centered care directly to them. We are leading the charge in healthcare innovation, bringing multispecialty provider services and forward-thinking technology to skilled nursing facilities across the country.

We're looking for a Medical Assistant to join our post-acute care team on a temporary basis to serve as the vital connection between residents, providers, nursing staff, and families, coordinating care, facilitating telemedicine visits, and reinforcing patient education to drive better outcomes in a value-based care model.

• Facilitate in-room telemedicine visits and schedule acute, follow-up, and routine provider appointments
• Prepare and support residents during provider visits, including positioning and documentation
• Update EHRs with medical histories to support care plans and visit encounters

• Support smooth transitions of care across the post-acute continuum, including referrals and follow-up appointments
• Facilitate prior authorizations and assist residents with ACO Voluntary Alignment forms
• Reinforce provider instructions and educate residents on nutrition, fall prevention, medication reminders, and general wellness
• Distribute provider-approved materials and route clinical concerns to licensed staff or providers
• Documentation & Administrative Support
• Maintain accurate documentation in the EMR and support regulatory compliance and quality initiatives
• Fosters a culture of best-demonstrated practices, customer and peer service orientation, measurement, performance, accountability, and continuous improvement
• Manages the Transition of Care process from admission to transition home (i.e., admission, discharge planning, and follow-up)
• Monitors active patients across care settings (hospitals and SNFs)
• Visits facilities (hospitals and SNFs) on a routine basis
• Serves as a resource for the patient and their family to help solidify the discharge and treatment plan
• Facilitates and clarifies the patient’s goals of care with the facilities and attending physicians
• Assists with discharge planning from inpatient or skilled nursing settings
• Works collaboratively with the clinical coordinator to ensure discharge data is appropriately documented and transition-of-care visits are scheduled and verified with the patient/family
• Will collaborate with the Community Medical Director daily to review the appropriateness of discharge plans
• Reviews with the CMD the medical necessity of Home Health orders and DME orders, and follows up with those HH and DME agencies on their treatment plan
• Facilitates access for patients to verify their ancillary services (e.g., DME, Home Health, outpatient rehab) are in place and meeting their needs
• Attends Interdisciplinary Team (IDT) meetings and provides additional information on patients
• Serves as the face of [Company Name] in the hospital/SNF when physicians cannot be onsite (e.g., bringing in notes, POLST, etc.); patients recognize them as part of the [Company Name] program
• Assists physicians with communicating with the attending of record
• Arranges family meetings in the SNF and hospital
• Develops relationships in the admitting, ED, and Case Management departments in the facility setting
• Coordinates with the facility’s Case Management and Social Work teams on the discharge
• Develops relationships with SNF administrators
• Obtains access to clinical records in the facility setting, and reviews and facilitates medical-records transfer to [Company Name]
• May conduct home visits based on community team needs
• Ability to explain the [Company Name] care model and engage new members into the program
• Other tasks needed to accomplish the team’s objectives and goals

• Graduate of an accredited Medical Assistant (MA) program
• Certified Medical Assistant (CMA) preferred
• Prior experience as a Medical Assistant in a clinical or care-coordination setting;
  Health Plan / Hospice Liaison experience preferred
• Managed…