Care Coordinator Innovation Care Partners

HonorHealth•Mountain View, AZ

3d•Onsite

About The Position

The Care Coordinator I collaborates with the primary physician and other healthcare team members to develop patient-centered goals and actions that reflect the total care needs and resources of patients and their families. The coordinator serves as a patient advocate throughout the continuum of care and is a resource for physicians, patients, and families to facilitate communication. The role provides coaching and care coordination to assigned patients, supporting effective transitions across ambulatory care, hospital, home, and skilled nursing settings. It serves as an embedded care resource focused on the health, wellness, and care coordination needs of the patient population. The position is based at Innovation Care Partners in Scottsdale, Arizona, and is scheduled Monday through Friday, 8:00 a.m. to 4:30 p.m.

Requirements

High school diploma or GED.
At least 1 year of outpatient, ambulatory care, specialty care, or community healthcare experience.
Basic Life Support (BLS) certification/CPR card.
For employees conducting home visits, a current Arizona Fingerprint Clearance Card is required within 8 weeks of hire.

Nice To Haves

Associate degree in business, health administration, or a related field.
At least 2 years of experience in an outpatient clinical setting working with primary care physicians, and home care experience.
Preference given to honorably discharged veterans.
Emergency Medical Technician (EMT) license, medical assistant (MA) qualification, paramedic BLS, or equivalent military experience.

Responsibilities

Coach and guide patients and caregivers on critical issues and self-management tasks that support recovery.
Use active listening, Behavioral Motivational Interviewing, guided care goal setting, and home visits to build relationships and communicate face to face.
Document every patient encounter accurately and completely.
Coordinate with clinical practitioners, including home health nurses, physicians, and physician assistants, to review patient progress and ability to manage healthcare issues.
Educate and empower patients and caregivers to support their healthcare and help prevent the need for additional resources or hospital admissions.
Perform outbound calls, home visits, and appointment scheduling as needed.
Assist with medication reconciliation, post-discharge home care coordination, self-management support, follow-up care, supportive care, advanced care planning, community resources, and long-term planning.
Report patient compliance or non-compliance with medical care instructions to appropriate clinical staff.
Communicate clearly and professionally with clinical teams, patients, and caregivers through email, technology, written, and verbal communication.
Ensure safe handoffs of hospitalized and post-acute patients from Transitional Care Managers to Care Coordinators.
Coordinate outpatient follow-up appointments and plans of care with primary care physicians and specialists.
Coordinate care with internal and external providers and other healthcare team members.
Build and maintain working relationships with patients, caregivers, and healthcare partners.
Independently manage a high-volume caseload with minimal direction, anticipate and organize workflow, and respond to rapidly changing priorities.
Collaborate with HonorHealth staff, social service organizations, and community resources to meet patient needs.
Maintain working knowledge of applicable laws and regulations and Medicare, Medicaid, SSI, SSDI, and insurance benefits.
Perform other duties as assigned.