The Care Coordinator (CC) is responsible for coordination of care for chronic health management in the clinic setting. The CC will identify patient needs, track gaps in care management, and facilitate follow up and referral with the appropriate primary and specialty care providers. The CC will utilize interdisciplinary and interagency coordination and referral to meet patient needs. The CC works with the nursing department to facilitate integration of case management with daily patient visits the quality and informatics department. This position includes tracking and trending of chronic health issues to ensure compliance with standards of care and optimum patient health outcomes. The CC also functions as an RN staff resource.