The role of the Patient-Centered Medical Home (PCMH) Care Coordinator is a nurse that works collaboratively with the physicians, staff and other health care professionals to actively facilitate health care delivery and promote care team communication for an assigned patient population ensuring appropriate care is provided. This role involves identifying patients that qualify for care coordination, such as those not meeting clinical goals and quality measures, overdue for visits, labs, or referrals, and arranging for follow-up services as appropriate. The coordinator will manage chronic care for medically complex children, identify gaps in care, and implement appropriate actions to address them. Effective and professional communication with patients, care teams, and providers is essential to support continuity of care. The coordinator will also identify patient needs and/or barriers (psychosocial and other) to care and coordinate patients/families' contact with community resources.
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Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree