SUMMARY: The Care Coordinator works as an integral part of the Program Team. The Care Coordinator will perform, but not limited to the following duties: collaboration and continuous partnership with chronically ill or “high risk” enrollees and their family/caregiver(s), clinic/hospital/specialty provider, staff, and community resources in a team approach. This position requires a flexible schedule including 1^st and 2^nd shift. The agency has the right to change shifts based on the needs of the organization.

ESSENTIAL FUNCTIONS:

Position Specific Duties:

• Serve as a contact point, advocate, and informational resource for enrollees, care team, family/caregiver(s), payers and community resources.
• Work with consumers to plan and monitor care: assess consumer’s unmet health and social needs.
• Develop a care plan with the consumer, family/caregiver(s) and providers (emergency plan, health management plan, medical summary, and ongoing action plan as appropriate).
• Monitor adherence to care plans, evaluate effectiveness, monitor consumer progress in a timely manner, and facilitate changes as needed, create ongoing processes for consumer and family caregiver(s) to determine and request the level of care coordination to support their desire at any given point in time.
• Facilitate consumer’s access to appropriate medical and specialty providers.
• Educate consumers and family/caregiver(s) about relevant community resources.
• Facilitate and attend meetings between consumer, family/caregiver(s), care team, payers and community resources as needed.
• Cultivate and support primary care and specialty provider co-management with timely communication, inquiry, follow-up, and integration of information into the care plan regarding transitions-in-care and referrals.
• Assist with identification of “high risk” enrollees (the chronically ill and those with special health care needs), and flag in the EMR.
• Provide feedback for the improvement of care coordination.
• Ability to climb three flights of stairs to deal with emergencies.
• Ability to respond to emergency situations by placing calls to Fire, Rescue, Police and Medical, etc.

Administrative Tasks:

• Complete all required documentation in a timely manner.
• Perform program recordkeeping and filing and organize vital documents.
• Provide telephone coverage for the assigned program and direct calls to other programs as needed.
• Participate in required supervisions, staff meetings and trainings.
• Participate and cooperate in any investigations conducted by internal and external agencies.
• Ability to use a computer including inputting information into data systems.

Compliance Requirements:

• Remain awake during your shift at all times.
• Attend all mandatory trainings and update all licenses and certifications.
• Adhere to program/project/department requirements and services.
• Follow all reporting guidelines by deadlines including the completion of a Confidential Incident Report.

QUALIFICATION REQUIREMENTS: The Care Coordinator must perform each essential function satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. The qualifications listed below are representative of the knowledge/skill and/or ability required.

• Bachelor’s degree in human services field preferred.
• Minimum two years’ experience working with mental health/substance use disorders. 
• Local knowledge about and connection to community health care and social welfare resources desirable.
• Superior attention to detail, organizational skills, communication skills, and multi-tasking skills.
• Good working knowledge of computers, electronic health records and data collection.
• Requires valid driver’s license due to business-related travel.

WORK ENVIRONMENT REQUIREMENTS: The work environment requirements are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position. 

• The work noise level is that of an average busy home.
• Ensure safety through fire drills and emergency evacuations.
• Ensure a safe workplace to reduce potential risk of violence.
• Ensure a safe and clean program addressing and communicating any facility issues.
• Observe all health and safety requirements including Tuberculosis (TB) screening.
• Abide by the Hazard Communication policy and the disposal of hazardous waste.
• Abide by the Bloodborne Pathogens/Universal Precautions policy and procedure.
• Adhere to all emergency evacuation procedures.

PHYSICAL REQUIREMENTS: The physical requirements are representative of those that must be met by an employee to successfully perform the essential functions of this position. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Requires good vision (the ability to see) either with or without various assistive devices.
• Requires the ability to hear either with or without various assistive devices.
• Requires the ability to communicate information effectively to others both verbally and in writing.
• Some manual dexterity is required in carrying out applicable aspects of position responsibilities.
• Some manipulative ability is required in carrying out applicable aspects of position responsibilities.
• Position requires overall light physical effort.
• Frequent climbing of stairs is required in carrying out applicable aspects of position responsibilities.
• Ability to quickly move throughout the facility in carrying out applicable aspects of position responsibilities
• Ability to quickly perform emergency-type actions as needed (Police, Fire, Medical, etc.)