The Care Coordinator operates under the HCA Health Home Care Coordination Organization and the designated Health Home Lead. The Care Coordinator directly interacts with Health
Home service beneficiaries and is responsible for the conversion of beneficiaries from outreach to engaged.
Care Coordinator works with beneficiary to develop a Health Action Plan that includes a client-driven long-term goal, coinciding short-term goals and specific action steps as well as required and clinically indicated screenings.
The Care Coordinator is responsible for supporting beneficiaries and their families in coordinating the beneficiary’s healthcare services and increasing the beneficiary’s and family’s knowledge and skills to be able to self-manage healthcare needs.
The Care Coordinator provides six Health Home services to beneficiaries on caseload as appropriate and needed. These services include comprehensive care management, care coordination and health promotion, transitional care planning and follow-up services, individual and family education and collaboration, community, and social support services referral coordination, and use of health information technology.Integrity Nurse Consultants dba
Integrated Wellness CMS
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The role of the Care Coordinator involves direct coordination, advocacy, and education to assist the beneficiary in understanding the healthcare system and to access services for physical and behavioral health needs.
Essential Position Functions:
• Coordinates and oversees Health Home benefit services by
actively engaging beneficiary via completion of Health Action Plan and supporting the beneficiary to achieve their short and long-term goals.
Responsible to maintain adequate number of beneficiaries currently outreaching to, necessary to maintain a caseload of 55.
• Meets with beneficiary on monthly basis and/or
actively assisting and coaching beneficiary on action steps related to long and short-term goals.
Responds to individual cases per Health Home scope of services, e.g., follow-up with beneficiary in the hospital prior to discharge or within two days of discharge in the event beneficiary is hospitalized.
• Review Health Action Plan every four months with each
beneficiary to maintain eligibility for services.
Marginal Functions of the Position:
• Complete projects and tasks as assigned by supervisor;
• The ability to prioritize projects needing to be completed in a timely manner;
• Collaborate
with and train staff on proper operation and maintenance of program systems and equipment;
• Availability to be reached and respond quickly to facility emergencies.
QUALIFICATIONS AND EDUCATION REQUIREMENTS
Qualifications:
• Must have excellent verbal and written communication skills;
• RN license;
Associate’s Degree or higher in Social Work, Psychology, or related field with relevant professional experience and License; LPN diploma or degree with 1-2 years nursing experience
• Ability to effectively use computer and communication technology; • Able to work independently and communicate effectively with clients and supervisors.
• Ability to work in
fast-paced environment and daily prioritize and complete tasks. • Ability to maintain professional boundaries and practice self-care.
PREFERRED SKILLS
Dependable and responsible;
• Likes people and has a nurturing and caring attitude;
•
Organized, self-motivated, honest, and mature;
• Must be able to operate office equipment
including but not limited to computer keyboards, multi-line phone system, fax and copy machines, Ability to pass a background and criminal history check.
Integrity Nurse Consultants dba Integrated Wellness CMS
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ADDITIONALNOTES
Come and join our team! We are a Nurse-owned agency and are looking to add several Nurses, Social Workers, Medical Assistants and CNAs and to our team!
*Competitive pay*
*Continuing education opportunities*
*Very flexible shifts & schedules*
*Supportive office staff*