Job Summary
The Care Coordinator will be an integral member of the care management team, responsible for assisting in outreach and case management for patients receiving care management services. The role supports the care teams, aligns with Christian Community Health Center’s mission, vision and values, and follows the organization’s policies and procedures, including all Customer Service Standards.
Responsibilities
Monitors the Medical Home Network (MHN) portal.
Collects and submits required documents for the care management model, including medical records, referral/consult notes, and post‑hospitalization records.
Participates in initial patient screening, surveys, reminder phone calls, and patient education under the guidance of the care team.
Follows up with patients in hospital or clinic settings as needed.
Audits patient records.
Serves as a trained health coach to patients (motivational interviewing training provided).
Connects patients and the Medical Home to community‑based services and provides care management.
Assists patients in utilizing health‑care services and referrals within and outside their insurance plans.
Schedules appointments and ensures compliance with attendance.
Documents all correspondence in the MHN portal and electronic medical records, as required.
Collaborates with the patient’s Medical Home to arrange conference calls as needed.
Works with the care management team to develop individualized patient care plans.
Improves identified outcomes using MHN quality measures.
Identifies and mitigates extrinsic barriers to adherence (e.g., transportation, financial concerns, pharmacy) and works with the team to alleviate them.
Acts as liaison to multiple departments, agencies, and provider offices.
Performs related duties as assigned.
Minimum Qualifications / Experience & Skills
High school diploma or equivalent (required).
No licensure required; at least three years of experience in a medical office with ambulatory care exposure.
One to three years of experience with electronic medical records.
Completion of a Medical Assistant program preferred.
Knowledge of the needs of highly complex patients.
Strong verbal and written communication, interpersonal and organizational skills.
Ability to multi‑task and be self‑motivated.
Ability to work effectively independently and as part of a team.
Bilingual skills highly desirable.
Employee Benefits Offered To Full‑time Staff
Blue Cross Blue Shield Medical Insurance
Blue Cross Blue Shield Dental and Vision Insurance