The Health Homes Care Coordinator manages a caseload of individuals with chronic physical health, mental or behavioral health, and social needs. The role coordinates comprehensive medical and behavioral health care for people with chronic conditions through care coordination and integration, helping ensure access to appropriate services and improve health outcomes. A primary goal is to reduce avoidable emergency room visits and hospital admissions through care management services. Services include linking and referring clients to appropriate community services, coordinating with community providers, hospitals, and family members, and offering prevention and wellness support. The coordinator completes comprehensive assessments, develops care plan goals with clients, monitors and documents services and progress toward goals, and records client engagement in detailed progress notes. The employee may also take on other duties assigned by the Director or Supervisor of Health Homes to complete program tasks.
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Job Type
Full-time