Care Coordinator

About the position

The Care Coordinator is a member of the OLE Health clinical care team and works in continuous partnership with the patient, their family when appropriate, OLE Health care team, and relevant community partners to improve health outcomes and meet the patient's desired health and wellness goals. This role involves serving as the contact point, advocate, and informational resource for patients, family/caregiver(s), primary care team, payers, and community resources. The Care Coordinator facilitates access to internal and external services, identifies and addresses gaps in care, and increases the patient's ability for self-management and shared decision-making.

Responsibilities

• Evaluates social determinants of health, identifies barriers to care and addresses/resolves obstacles impeding progress.
• Processes and closes the loop for community resource referrals.
• Provides warm hand-offs for urgent and stat medical referrals and collaborates with referral coordinators to ensure medical referrals are processed.
• Works with direct supervisor and QI department to ensure quality improvement initiatives are met.
• Meets with each new patient and orients patient and family/caregiver(s) to CommuniCare+OLE.
• As a member of the care team, participates in huddles, team meetings, and case conferencing as needed.
• Educates patient and family/caregiver(s) about relevant community resources.
• Coordinates warm hand-offs for integrated care providers.
• Provides support to primary care providers by completing forms and other tasks as needed.
• Provides care management and creates care plans for patients on high-risk registry.
• Documents timely and efficiently in the EMR.
• Attends appropriate training courses/webinars and meetings.
• Gathers and reports data related to aspects of care coordination when needed.
• Provides feedback for the improvement of Care Coordination processes.
• Perform other duties as assigned.

Requirements

• High School Diploma or equivalent.
• Experience working with diverse populations; displays respect and sensitivity to cultural diversity.
• Experience working in community health setting.
• Strong collaborative skills; ability to effectively and appropriately engage members of the care team, other clinic departments, leadership, and external community partners.
• Exceptional communication skills; ability to effectively engage patients and assess needs and concerns to ensure that the patient is referred appropriately.
• Excellent in-person and phone customer service skills; able to manage difficult and emotional patient situations and to respond promptly to patient needs.
• Ability to adapt to change; approach challenges with an innovative and proactive attitude; and investigate resources.
• Strong verbal and written communication skills required; Bilingual (English/Spanish) required.
• Must certify and remain current in CPR.

Nice-to-haves

• Knowledge of Organizational Improvement Methods.
• Knowledge of care coordination best practices.
• Knowledge of Federally Qualified Health Centers and the key health center principles and guidelines.

Benefits

• Medical, Dental, Vision Coverage.
• Employer covers 90% of employee medical, dental and vision premium and 50% of dependent premium.
• 18 days of PTO (Vacation & Sick).
• 10 Paid Holidays + 1 Float Holiday.
• 4% Employer Match for 403(b) retirement plan.
• Tuition Reimbursement of up to $2,000 per Calendar Year for part-time and full-time employees (prorated per Full-Time Equivalent).
• Life & Accidental Insurance Coverage.
• Employer contribution for Health Savings Account.
• Flexible Spending Account (FSA) and Limited FSA Options.