Care Coordinator I or II

Position Summary

The Care Coordinator is responsible for being part of a clinical care team and enhancing quality and patient-centered care. This is accomplished by assessing gaps in care for patients with chronic conditions and/or mental health needs and creating a plan with the clinical care team during daily huddles. Will assist patients with medication management, access to insurance, and help identify any other preventive health needs. Will also assist patients with ongoing self-management goal setting utilizing Motivational Interviewing skills.

Duties and Responsibilities

• Participate in morning huddles to anticipate the patient’s clinical, social and behavioral health needs
• Work with the care team to identify gaps in care and work to resolve them using process improvement strategies
• Provide brief interventions at point of care to assist patients with management of their chronic illness, address any social needs and link patients to behavioral health
• Advocate for patient services with community, social service, and medical providers
• Coordinate care transitions for patients who have been seen in an emergency room and/or have been discharged from a hospital/long-term care facility
• Track patient’s adherence with plan of care in electronic or paper charts and communicate outcomes and recommendations to the primary care provider
• Function as a point person within the clinic care team regarding chronic disease management and improvement activities to improve clinical quality measures
• Organize monthly Health Home meetings by working with the Clinic Operations Team/Clinic Manager, create the agenda and help facilitate the meeting
• Collaborate with clinical care team to improve Patient-Centered Medical Home processes and provide documentation demonstrating performance
• Generate reports for care teams to identify areas of improvement and monitor sustainability of each quality measure

Qualifications and/or Experience

• Must be able to work independently, prioritize workload, and meet deadlines
• Must have critical thinking skills and maintain confidentiality
• Must have excellent organizational skills and ability to handle a variety of tasks simultaneously
• Must have knowledge of medical terminology and/or behavioral health topics
• Must have strong decision making and prioritization skills
• Must be able to work respectfully and professionally with the community, patients, families and staff
• Able to work effectively in a multi-cultural environment with a diverse population
• Sympathetic, mature, responsible, and reliable
• Strong patient engagement, interpersonal, and communication skills and ability to establish a therapeutic relationship with the patient

Education, Certificates, Licenses, and Registrations

• For Care Coordinator I, must have Medical Assistant Training with one or more years of experience in a community health setting or family practice, or, one or more years of equivalent experience. Current licensure is not required for this position
• For Care Coordinator II, must be an LPN with experience in ambulatory care and/or have a BA/BS/BSW in health-related field with one year of experience working in community health, or, 4 years of equivalent experience. The LPN does not have to have an active license; this is a non-licensed position

What We Offer

• Fringe benefits surpass most companies
• Medical
• Dental
• Vision
• Prescription coverage
• Life Insurance
• Long Term Disability
• EAP (Employee Assistance Program)
• Paid-time-off starting at 24 days per year + 10 paid Holidays
• 401(k)/Retirement options
• Opportunity to work in a culturally diverse environment

How to Apply

To apply for this position, complete the online application and click SUBMIT or APPLY NOW. If you have any questions regarding the position, email Brenda Solis, HCA, at brendasolis@seamarchc.org.