The Care Coordinator is responsible for aiding the care management team by working collaboratively to support patient care plans and needs. Serving as an advocate for patients, the Care Coordinator will be part of the care management team and work in tandem with care managers, healthcare providers and community-based organizations to improve outcomes for patients they serve. Working within his/her scope of practice, this role coordinates between health care services, recognizing the holistic needs of the patient, inclusive of patient specific social and cultural dynamics. The Care Coordinator may work remotely within regions to cover the needs across the network. This position will support CMHN goals and objectives in meeting performance improvement targets, meeting expectations of standardizing the plan of care, and supporting team development.
This position has two levels: Care Coordinator I and Care Coordinator II based on education and breadth of scope.
Experience: Minimum of (3) three years of experience in an ambulatory/care management or acute care setting, home health, or public health.
Minimum Qualifications (Degrees/Certificates)
Care Coordinator I: High School graduate or GED; completion of certificate program in healthcare area of focus.
Care Coordinator II: 2-year degree in human services or nursing field; CMA or LPN preferred.
Current and Active Certification or License from an accredited school or program.
Up to date on required immunizations.
Knowledge, Skills and Abilities
- Proficiency in Microsoft Office Outlook, Word, Excel, PowerPoint use and e‐mail communication.
- Ability to communicate clearly and succinctly.
- Excellent verbal and written communication skills.
- Must be able to work with changing priorities.
- Requires excellent organizational, problem solving and critical thinking skills.
- Must be able to interact with individuals of all cultures and levels of authority.
- Requires the ability to maintain confidentiality.
- Must be able to function as part of a team.
- Experience with electronic documentation systems.
- Engages with patients to identify and address barriers that impede health outcomes
- Implements and support Care Management interventions per the patient’s care plan or assessed community needs
- Processes referrals from members of the multidisciplinary team (social work, behavioral health, community resource coordinators, pharmacy, pharmacy technician, care managers) appropriately, accurately and timely according to established workflows
- Schedules home visits and/or practice encounters with patients via phone or correspondence based on referrals and according to policies and procedures
- Documents all interactions with patients/others appropriately in the care management software
- Schedules/verifies appropriate medical appointments for patients as needed
- Coordinates referrals to outside agencies as directed by interdisciplinary team in a timely fashion.
- Provides education to patient/family within scope of practice.
- Serves as a liaison among the patient/family, community services, primary providers, specialists, and other care team members to coordinate services.
- Maintains appropriate documentation in the Care Management documentation platform, in accordance with organizational policies and procedures.
- Participates in Quality Improvement initiatives to improve efficiency and effectiveness of patient health outcomes.
- Adheres to NCCHCA privacy and security policies.
- Abides by Health Center guidelines, policies and procedures, and HIPAA regulations.
- Attends departmental and corporate meetings, local and regional trainings, or other events as required.
- Willingly performs other duties as assigned.
- Provides educational information to care team, patients, family and care givers, about community-based organizations (existing and new) within service area.
- Works on-site at assigned Community Health Centers as required by the needs of the patients or the health center and according to policies and procedures.
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- While performing the duties of this job, the employee is regularly required to, stand, sit, talk, hear, and use hands and fingers to operate a computer and telephone keyboard reach, stoop & kneel to install computer or AV equipment.
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
- Moderate noise (i.e., business office with computers, phone, and printers, light traffic) when on-site at an assigned community health center
- Ability to work in a confined
- May work remotely as defined by the health center or NCCHCA policy, up to 50%+.
- Must have adequate and reliable internet access at home. Laptop, monitor, headphones, and lab jackets will be provided by NCCHCA. Laptops, monitors and headphones are for use only at approved home office.
- Ability to sit at a computer terminal for an extended period or drive distances to your preassigned community health
- Must have an operational automobile and current active NC drivers’ license and auto
The above statements are intended to describe the general nature and level of work being performed by individuals assigned to this job. They are not intended to be an exhaustive list of all responsibilities, duties and skills required of the position. All employees may have other duties assigned at any time.