Pediatric Care Coordinator

Fair Haven Community Health Care•New Haven, CT

About The Position

The Pediatric Care Coordinator is a vital member of the interdisciplinary patient care team. This role provides patient navigation and facilitates access to care based on EHR data and referrals from clinical teams. The Care Coordinator identifies any barriers that may impact a patient’s access to health, and will link them to appropriate services. Reporting to the Care Coordination Program Manager, the Pediatric Care Coordinator’s role will involve in-person visits with patients and families as well as telephonic visits. Patients who have been identified as needing additional support services to navigate the healthcare system and access community resources, high utilizers of acute care or hospital services, or otherwise high-needs/high-cost patients, will comprise the panel of patients. The Care Coordinator will address through measurable efforts to improve health and adherence/access to health care. For over 54 years, FHCHC has been an innovative and vibrant community health center, catering to multiple generations with over 165,000 office visits across 21 locations. Guided by a Board of Directors, most of whom are patients themselves, we take pride in being a healthcare leader dedicated to delivering high-quality, affordable medical and dental care to everyone, regardless of their insurance status or ability to pay. Our extensive range of primary and specialty care services, along with evidence-based programs, empowers patients to make informed choices about their health. As we expand our reach to underserved areas, our commitment to prioritizing patient needs remains unwavering. FHCHC's mission is to enhance the health and social well-being of the communities we serve through equitable, high-quality, and culturally responsive patient-centered care.

Requirements

Associates degree in health-related field and/or relevant years of experience is required. Bachelor’s degree preferred.
A valid CT driver’s license and access to reliable transportation is required.
Experience in Care Coordination; working with teams; using EPIC electronic health record highly preferred.
The successful candidate will have excellent computer skills including word processing and data entry required and the ability to work independently.

Nice To Haves

Bilingual in English and Spanish is highly desirable.

Responsibilities

Outreach to patient populations based on gaps-in-care reports or other reports that have identified vulnerable patients and families
Conduct needs assessments at least yearly using a validated screening instrument on all patients with whom the Care Coordinator interacts
Use technological platforms to link patients with needs to community resources
Assist with and follow-up on the successful completion of health maintenance items (e.g. lab testing, annual visits) and chronic disease management (e.g. routine diabetic or asthmatic care)
Conduct home visits as needed
Identify barriers to care impacting patients’ abilities to adhere to treatments.
Assist patients with insurance enrollment, or other patient assistance programs
Work collaboratively with clinical teams to meet the needs of complex, high-cost patients
Attend relevant trainings as required and assigned.
Document client referrals, encounters, and services in the EPIC electronic health record and communicate securely with other team members and clinicians.
Maintain strict adherence to all deadlines including report deadlines and timely completeness of documentation.