Community Care Coordinator

Neighborhood Health Plan of Rhode Island•Smithfield, RI

8d•Onsite

About The Position

The Community Care Coordinator (CCC) works collaboratively with the health care team to manage and coordinate care for members with social needs, supporting quality, cost-effective, patient-centered care. The role works directly with members and clients, staff, managers, and internal and external customers. Under the direction of a Medical Case Manager, the coordinator performs ongoing care coordination, including outreach, health screening, referrals, access to care, and connection to social and community supports. The position also maintains documentation and community resource information, supports program improvement and quality activities, and participates in community and outreach activities. Occasional travel and a flexible schedule, including evenings and weekends, are required.

Requirements

Associate degree in a human-service-related field preferred, or equivalent years of background and experience equal to a degree.
Three to five years of experience in a medical or social services setting, or at least six months of experience working in a position at Neighborhood Health Plan of Rhode Island.
Experience working with the needs of individuals with behavioral health and/or long-term care needs.
Strong oral and written communication skills.
Strong customer service orientation and interpersonal skills.
Strong organizational skills and ability to problem solve and work independently.
Strong collaborative skills and teamwork values.
Computer literacy with Windows-based programs.
Sound judgment and strong time management skills.
Ability to keep accurate records and prepare reports.
Ability to work with minimal supervision.
Flexible schedule, including evenings and weekends.
Ability to travel for work; must have access to reliable transportation and/or a valid driver's license and proof of insurance.

Nice To Haves

Clinical specialty experience.
Knowledge of community social service resources, state agencies, and the state Medicaid program.
Knowledge of medical terminology.
Knowledge or expertise in substance use and/or mental health.
Bilingual.

Responsibilities

Conduct outreach and complete HRA and initial health screening.
Conduct telephonic initial screening of non-medical needs, coordinate services, and make appropriate referrals.
Provide members, clients, and/or their families with information about social and community support.
Assist with calls to social service agencies as appropriate.
Conduct off-site visits, such as to homes, hospitals, community health centers, or other community agencies, as necessary or required.
Support members in accessing care and services and making appointments.
Aid in obtaining medically necessary durable medical equipment (DME).
Direct members and clients to internal departments as appropriate.
Manage a caseload of identified and/or assigned members.
Document all activities and contacts in CMAQE or the appropriate software system.
Assist Medical and/or Integrated Care Managers in coordinating community resources as appropriate.
Participate in developing and maintaining a community resource database.
Calculate potential cost savings from interventions involving an alternative level of care, service, or resource.
Identify and pursue opportunities for professional development.
Recommend and participate in program improvements and quality improvement activities.
Serve as a resource for questions from ancillary departments within Neighborhood.
Participate in community events and projects as assigned.
Provide cross coverage as assigned by the Lead and/or Manager.
Participate in outreach and marketing activities as needed and appropriate.
Maintain up-to-date knowledge of resources in Rhode Island.
Comply with the Corporate Compliance Program, Standards of Business Conduct, applicable contracts, laws, rules and regulations, and company policies and procedures; exercise due diligence to prevent, detect, and report unlawful or unethical conduct.
Perform other duties as assigned.