• Assess and address health and safety issues as well as barriers to care and treatment including social determinants of health
• Collaborate with interdisciplinary team and incorporate input into comprehensive assessment and Life Plan
• Incorporate health promotion and support opportunities for individuals to achieve and maintain optimal health and wellbeing
• Meet with individuals and families face to face in the community and their homes
• Coordinate and ensure access to chronic disease management
• Facilitate referrals to clinical and community resources, including planning, referrals, and follow-up for transitional care 
• Coordinate and provide access to long-term care supports and services 
• Engage families and natural supports into the care coordination process
• Ensure all individuals and families receive services that are culturally and linguistically appropriate 
• Advocate on behalf of the individual
• Promote self-advocacy and the ability to self-direct
• Use Health Information Technology for documentation, to link services, and facilitate communication among care coordination team
• Secure all health records and other protected information with the highest regard to confidentiality and HIPAA laws and regulations
• Maintain compliance with all state and federal laws and regulations, Medicaid compliance, and PCC policies and procedures
• Document all services and maintain appropriate records following all established documentation procedures
• Represent PCC on workgroups, committees, advisory groups or networks as assigned
• Participate in opportunities for continued training and education 
• Perform all other duties relevant to the position as requested.

• Ability to act quickly, assess and act accordingly in crisis situations
• Basic technology skills and understanding of health records
• Knowledge of ethical and professional responsibilities and boundaries
• Demonstrate professional work habits including dependability, time management, independence and responsibility

• Associates Degree or equivalent earned college credits in Health or Human Services or related field OR a Bachelor’s degree 

The listed salary range represents the organization's good faith and reasonable estimate of the range of possible compensation at the time of posting. The offered salary will be determined by: Applicant qualifications and experience, education, position specific licensing/training and departmental budgets.

Prime Care Coordination is committed to equal employment opportunity. We recruit, employ, train, compensate, and promote without regard to race, religion, color, national origin, age, sex, disability, protected veteran status, or any other basis protected by applicable federal, state, or local law. Prime Care Coordination will make reasonable accommodations for known physical or mental limitations of otherwise qualified employees and applicants with disabilities unless the accommodation would impose an undue hardship on the operation of our business. If you are interested in applying for an employment opportunity and feel you need a reasonable accommodation pursuant to the ADA, please contact us at 585-341-4600