Care Coordinator

Responsible for providing overall support to clients experiencing significant barriers to access and retention in care including development of care plans for all clients referred to the program and linkage to the appropriate supportive services. Must build and maintain positive working relationships with the clients, providers, nurse case managers, agency representatives, supervisors and office staff.

Scope of Duties:

1. Complete Care Plans on all assigned clients based on approved agency assessment tools with client input.


2. Assist clients with understanding care plans and instructions and motivate clients to be active, engaged participants in their health.


3. Assist clients with scheduling medical appointments and follow up with providers to ensure client attendance.


4. Assist clients with scheduling transportation to appointments and accompany clients to appointments as needed.


5. Facilitate health education to assist clients with disease management and schedule on site workshops with community resources.


6. Build and maintain positive working relationships with the clients, providers, nurse case managers, agency representatives, supervisors and office staff.


7. Help clients in utilizing resources, including scheduling appointments and assisting with completion of applications for programs for which they may be eligible.


8. Assist clients in accessing health related services, including but not limited to obtaining a medical home, providing instruction on appropriate use of the medical home, overcoming barriers to obtaining needed medical care and social services.


9. Assist in the collection of outcome data.


10. Maintain timely, accurate and clear documentation in accordance with agency requirements.


11. Attend and participate in team meetings, communicate with county and community-based agencies/professionals, patient care coordination and navigation.


12. Manage all referrals made to the Medical Respite Program. Interact (verbally and non-verbally) with all clients, staff, and community members professionally with respect and courtesy.


13. Maintain client and staff confidentiality in compliance with administrative policies and procedures.


14. Attend and participate in regularly scheduled staff meetings, supervisory conferences and training sessions.


15. Other duties as assigned.

 ADA Essential Functions:

1. Occasionally required to smell, stoop.


2. Regularly required to use hands to handle or feel.


3. Regularly required to reach.


4. Regularly required to stand, walk, sit, talk and hear.


5. Regularly required to lift and move up to 10 lbs.


6. Ability to see clearly at 20 inches or less.


7. Ability to observe an area that can be seen up and down or to the left and right while remain fixed on a given point.