Care Coordinator

JOB SUMMARY

The role of the Care Coordinator is to promote quality, cost-effective outcomes for a population by facilitating collaboration and coordination across settings, identifying member needs, and advocating to ensure member’s receive services and resources required to meet desired health and social outcomes. The Care Coordinator is responsible for providing patient centered care across the care continuum.

DUTIES & RESPONSIBILITIES

• Collect relevant clinical data to support the care planning process.
• Provide care plan support and intervention to transition members to optimal levels of health and self-management, as directed.
• Collaborate across providers and healthcare settings to ensure optimal quality outcomes for an assigned population.
• Provide transition of care interventions as required.
• Track members’ progress post-discharge, ensuring adherence to follow-up appointments.
• Facilitate care coordination, self-management planning, discharge planning, and health education as directed.
• Assist members in connecting with community resources, durable medical equipment providers, and home health services as needed.
• Adjudicate referrals according to defined business rules across all care settings.
• Maintain accurate, timely, and thorough documentation of all member interactions and interventions.
• Escalate complex cases to clinical staff.
• Adhere to the Policies and Procedures set forth by the Quality Management Committee and performs all additional duties as assigned.

EDUCATION AND PROFESSIONAL EXPERIENCE

• High School Diploma
• Minimum 2 years of experience in medical care management.
• Experience interpreting health plan benefit decisions.
• Bilingual Required (English/ Spanish)
• Certification as a Medical Assistant preferred.

PROFESSIONAL COMPETENCIES

• Strong understanding of care transition processes, including discharge planning and post-acute care needs.
• High level of critical thinking and problem-solving skills
• Strong work ethic and overall positive attitude
• Effective communication skills including verbal and written.
• Ability to manage time effectively, understand directions, and work independently in a fast-paced environment.
• Proficiency in EHR systems and Microsoft Office Suite.
• Demonstrated flexibility, organization, and self-motivation.
• Highly adaptable to change.

WORK ENVIRONMENT

The majority of work responsibilities are performed in an open office setting, carrying out detailed work sitting at a desk/table and working on the computer.