Care Coordinator

Brattleboro Memorial Hospital•Brattleboro, VT

1d•$25 - $33

About The Position

POSITION SUMMARY: Embedded in the Primary Care, the Care Coordinator provides consultation to the medical and social service treatment teams providing screening, case management and resource coordination and assisting in discharge planning when appropriate. The Care Coordinator is an integral member of the care team and provides case management, discharge planning and resource coordination to patients as well as provides routine follow ups on services for patients of Brattleboro Family Medicine. DEPT. SCOPE OF SERVICE: The BMH-owned or managed physician practices provide medical services in various specialties and offices including pediatrics, OB/GYN, cardiology, orthopedics, general surgery, family practice and internal medicine. The practices are staffed by physicians and other licensed providers who are supported by clinical staff (RNs, LPNs or medical assistants) and clerical staff (receptionists, transcriptionists, file clerks). Hours vary by practice. KEY RESPONSIBLIES: Provides consultation with team members, and takes referrals from them to outside resources Collaborates with clinicians to assess and establish plan of care for complex patients including setting priorities with the patient/family. Assists individuals and families with identifying and prioritizing goals. With individuals, formulates time-limited treatment plans that target clearly identified treatment goals with a means of measuring success and treatment completion Provides care coordination and resource connection. Establishes relationship with community team, other providers, partner community agencies, and identified support systems for patients, collaborating as indicated. Completes periodic reports as required by BMH and or the state. Adheres to professional and ethical conduct at all times. Maintains accurate and timely clinical documentation in the EHR. Demonstrates the ability to coordinate patient care with a proactive approach to both acute and chronic conditions while being an advocate for the patient’s rights, value and belief systems.

Requirements

Bachelor’s degree in science or arts.
3-5 years recent experience in Care Coordinator/Care Management preferred.
Hospital experience preferred
Current Healthcare Provider CPR certification
OSHA Category I - Tasks that involve exposure to blood, body fluids, or tissues require use of techniques of Universal Precautions as evidenced with blood borne pathogens standards.

Responsibilities

Provides consultation with team members, and takes referrals from them to outside resources
Collaborates with clinicians to assess and establish plan of care for complex patients including setting priorities with the patient/family.
Assists individuals and families with identifying and prioritizing goals.
With individuals, formulates time-limited treatment plans that target clearly identified treatment goals with a means of measuring success and treatment completion
Provides care coordination and resource connection.
Establishes relationship with community team, other providers, partner community agencies, and identified support systems for patients, collaborating as indicated.
Completes periodic reports as required by BMH and or the state.
Adheres to professional and ethical conduct at all times.
Maintains accurate and timely clinical documentation in the EHR.
Demonstrates the ability to coordinate patient care with a proactive approach to both acute and chronic conditions while being an advocate for the patient’s rights, value and belief systems.