Position Summary

The Care Coordinator is responsible for providing assistance to the care management team by working collaboratively to support patient care plans and needs. Serving as an advocate for patients, the Care Coordinator will be part of the care management team and work in tandem with care managers, healthcare providers and community-based organizations to improve outcomes for patients they serve. Working within his/her scope of practice, this role coordinates between health care services, recognizing the holistic needs of the patient, inclusive of patient specific social and cultural dynamics. The Care Coordinator may work remotely within regions to cover the needs across the network. This position will support CMHN goals and objectives in meeting performance improvement targets, meeting expectations of standardizing the plan of care, and supporting team development.

Principal Duties and Responsibilities*

• Engages with patients to identify and address barriers that impede health outcomes.
• Implements and supports Care Management interventions per the patient’s care plan or assessed community needs.
• Processes referrals from members of the multidisciplinary team (social work, behavioral health, community resource coordinators, pharmacy, pharmacy technician, care managers) appropriately, accurately, and timely according to established workflows.
• Documents all interactions with patients/others appropriately in the care management software.
• Schedules/verifies appropriate medical appointments for patients as needed.
• Establishes partnerships with outside agencies to support patients’ social determinants of health needs.
• Coordinates referrals to outside agencies as directed by interdisciplinary team in a timely fashion.
• Provides education to patients/family within scope of practice.
• Serves as a liaison among the patient/family, community services, primary providers, specialists, and other care team members to coordinate services.
• Maintains appropriate documentation in the Care Management documentation platform, in accordance with organizational policies and procedures.
• Participates in Quality Improvement initiatives to improve efficiency and effectiveness of patient health outcomes.
• Adheres to NCCHCA privacy and security policies.
• Abides by Health Center guidelines, policies and procedures, and HIPAA regulations.
• Attends departmental and corporate meetings, local and regional training, or other events as required.
• Willingly performs other duties as assigned.
• Provides educational information to care team, patients, family and care givers, about community-based organizations (existing and new) within service area.
• Tracks Medicaid eligibility through provider portal and NC Tracks.
• Tracks, coordinates, and supports staff assisting with the PCP change form process.
• Collaborates with various NHC departments to execute CM tasks internally within the flows of the clinic.
• Functions as Health Equity champion for NeighborHealth Center.
• Manages info@neighborhealth emails and inquiries

Required Skills or Abilities*

1. Bilingual (Spanish) strongly preferred
2. Computer literacy in internet use and Windows environment, including Outlook, Word, and Excel with keyboarding skills of at least 45 wpm.
3. Ability to communicate clearly and succinctly.
4. Excellent verbal and written communication skills.
5. Must be able to work with changing priorities.
6. Requires excellent organizational, problem solving and critical thinking skills.
7. Must be able to interact with individuals of all cultures and levels of authority.
8. Requires the ability to maintain confidentiality.
9. Must be able to function as part of a team.
10. Ability to cultivate and develop inclusive and equitable working relationships with co-workers and community members.
11. Ability to serve as an advocate for individuals of all ethnicities, genders, ages, and backgrounds.

Required Knowledge, Experience, or Licensure/Registration

1. High School education or equivalent

2. Ability to work onsite/hybrid/remotely Mondays through Fridays during the hours of 7:45am and 5pm.

3. Ability to work remotely via a home office set up with access to secure Internet connection.

4. Ability to read, write, speak, and comprehend English fluently.

5. Up-to-date immunizations

Physical requirements of the Job*

Sitting or standing (often for prolonged periods)

Carrying or lifting objects up to 20 pounds

This is a full-time, nonexempt position.

*To comply with the Americans with Disabilities Act of 1990 (ADA), which prohibits discrimination against qualified individuals on the basis of disability, it is necessary to specify the physical, mental and environmental conditions of the essential duties of the job.

NeighborHealth Center is an Equal Opportunity Employer. NHC is dedicated to building a culturally diverse staff committed to serving a diverse patient population. We encourage applications from women, minority groups, veterans, and people with disabilities.