Clinical Care Coordinator
North Star Health, an independent Federally Qualified Health Center comprised of multiple PCMH practices delivering team-based care in Southern VT and Southwestern New Hampshire, is seeking Clinical Care Coordinator at our Springfield Health Center.
In this pivotal role, you will engage individuals seeking to prevent and manage chronic conditions, identify their priorities for their care, develop a care plan and coordinate its implementation in partnership with the patient, their care team and community partners.
In this role you Promote and work to achieve our mission and vision to connect with and care for our community so everyone may enjoy health and wellness.
Assess patients clinical, social, functional and continuing care needs to identify their priorities and the desired outcomes for their treatment.
In consultation with the patient, their care team and related partners, develop a care plan including immediate, short term, and long-term goals reflecting patients priorities and time frames to achieve desired outcomes.
Demonstrate knowledge and understanding of the clients diagnosis, prognosis, care needs, as well as cost and barriers to goal achievement.
Assist in transition of care though patient outreach, communication with relevant service providers following discharge from other care settings to ensure a smooth transition to outpatient care, with the goal of decreasing readmissions.
Communicate with patients and families in an effective, patient-centered manner; coordinate with other team members to provide exceptional patient service.
Maintain positive working relationships and demonstrate exceptional customer service skills.
Work cooperatively, address conflict and communicate effectively with all providers, team members, patients and their familiesFacilitate patient access to appropriate medical and specialty providers as well as other care coordination team supportServe as a point of contact, advocate, and informational resource for patient, family, care team, payers, and community resources and facilitate and attend meetings between patient, families, care team, payers, and community resources, as neededEnsure effective tracking of test results, medication management, and adherence to follow-up appointments.
Supports patient self-management of disease and behavior modification interventions.
Proactively outreaches to selected patients, perform home visits as necessary for assessment and engagement Participates in quality improvement activities, collecting and analyzing data Experience with Care PlanningTwo (2) years nursing experienceExcellent communication skillsProficiency with Microsoft Office, computer skillsCurrent LPN LicenseOne (1) - Two (2) years experience in case management (preferred)Current RN License (preferred)Interested candidates should provide a cover letter addressing the scope of the role, in addition to completing the application.
All new hires are required to show proof of COVID vaccination or request an exemption prior to starting work.
PI36193465fc83-31181-33731449 Recommended Skills Care Coordination Case Management Clinical Works Communication Consulting Customer Service Apply to this job.
Think you're the perfect candidate? Apply on company site Estimated Salary: $20 to $28 per hour based on qualifications.
In this pivotal role, you will engage individuals seeking to prevent and manage chronic conditions, identify their priorities for their care, develop a care plan and coordinate its implementation in partnership with the patient, their care team and community partners.
In this role you Promote and work to achieve our mission and vision to connect with and care for our community so everyone may enjoy health and wellness.
Assess patients clinical, social, functional and continuing care needs to identify their priorities and the desired outcomes for their treatment.
In consultation with the patient, their care team and related partners, develop a care plan including immediate, short term, and long-term goals reflecting patients priorities and time frames to achieve desired outcomes.
Demonstrate knowledge and understanding of the clients diagnosis, prognosis, care needs, as well as cost and barriers to goal achievement.
Assist in transition of care though patient outreach, communication with relevant service providers following discharge from other care settings to ensure a smooth transition to outpatient care, with the goal of decreasing readmissions.
Communicate with patients and families in an effective, patient-centered manner; coordinate with other team members to provide exceptional patient service.
Maintain positive working relationships and demonstrate exceptional customer service skills.
Work cooperatively, address conflict and communicate effectively with all providers, team members, patients and their familiesFacilitate patient access to appropriate medical and specialty providers as well as other care coordination team supportServe as a point of contact, advocate, and informational resource for patient, family, care team, payers, and community resources and facilitate and attend meetings between patient, families, care team, payers, and community resources, as neededEnsure effective tracking of test results, medication management, and adherence to follow-up appointments.
Supports patient self-management of disease and behavior modification interventions.
Proactively outreaches to selected patients, perform home visits as necessary for assessment and engagement Participates in quality improvement activities, collecting and analyzing data Experience with Care PlanningTwo (2) years nursing experienceExcellent communication skillsProficiency with Microsoft Office, computer skillsCurrent LPN LicenseOne (1) - Two (2) years experience in case management (preferred)Current RN License (preferred)Interested candidates should provide a cover letter addressing the scope of the role, in addition to completing the application.
All new hires are required to show proof of COVID vaccination or request an exemption prior to starting work.
PI36193465fc83-31181-33731449 Recommended Skills Care Coordination Case Management Clinical Works Communication Consulting Customer Service Apply to this job.
Think you're the perfect candidate? Apply on company site Estimated Salary: $20 to $28 per hour based on qualifications.
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