This job, in conjunction with the Practice Team, provides care planning, coordination and follow-up for patients at risk for poor outcomes or experiencing poor coordination of services. The Coordinator Health Care will complete a structured assessment of medical, bio-psychosocial support and self-management support needs. They will coordinate with and act as an advocate/liaison/contact to hospital, long-term care, specialty services, home health services, patient family, cultural and community resources for care managed patients. Accurately maintaining appropriate documentation on care coordination to promote Practice Team awareness and ensure patient safety and follow through on care plan is essential. This role also provides registration and billing functions; assisting patients in problem solving potential issues related to the health care system, financial and psychological barriers. Collaboration with primary care to establish and update a shared care plan, providing support for improving health behaviors and self-management skills (goal setting, action planning, problem solving) is key. The role also provides clinical workflow oversight. Other duties as assigned or requested.
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Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree