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Company: Comprehensive Community Health Centers Inc.
Location: Glendale
Posted on: August 6, 2022

Job Description:

Description: JOB SUMMARYThe Care Coordinator supports the CCHC Care Model by working with patients, families, providers, and staff. The Care Coordinator promotes/assists with timely access to needed care, provides daily continuity of care coordination and instructs patients, families and caregivers in an effort to help them understand the patient's care plan and self-care management responsibilities. The Care Coordinator is an essential member of the patient care team, who helps empower patients and families to take ownership and to have an active role in their healthcare.ESSENTIAL DUTIES AND RESPONSIBILITIES

  • Participate in daily care team huddles.
  • Treat patients with empathy and respect and conduct oneself in a professional manner.
  • Identify and monitor all patients based on risk and outcomes and actively identify patients for involvement in care coordination program
  • Engage patients, patients' families, and their caregivers in understanding, setting, and monitoring patient self-management care plans in a manner that is culturally and linguistically appropriate to the patient and caregiver.
  • Consult with patients, their family members and/or chosen support system to identify barriers and to set goals in correspondence with their health needs.
  • Comply with organizational guidelines and health laws and regulations.
  • Provide health education to patients about their health condition/s and related topics.
  • Complete health risk assessments as a foundation for developing individualized care plans and outcomes goals for patients and their families.
  • Document each patient's individualized care plan and care coordination in the Health Center's database.
  • Conduct follow-up calls/check-ins with the patient to determine progress with patient set goals
  • Coordinate the patient's care by facilitating patient, family, or other caregiver access to medical providers, staff, and resources as needed by the patient.
  • Conduct and document assessments of patient needs and resources for effective self-care management.
  • Develop and maintain relationships among patients, patients' families and the patients care team that support patients access to the medical home.
  • Apply the principles of comprehensive, community-based care, to provide developmentally, culturally and linguistically appropriate care coordination.
  • Use case coordination processes to assure quality care is delivered to the Health Center patients, the patients' families, and the patients' caregivers in the most efficient and effective manner across the healthcare continuum.
  • Research, find and link patients to resources, services and support mechanisms for their care plans and self-care management's needs.
  • Provide timely communication with patients, make inquiries, execute follow-up actions, and help to integrate information into the care plan.
  • Assist the care team by helping to measure quality and identify, refine, and implement performance improvements that support the medical home.
  • Assist the care team in performance evaluation and quality improvement.
  • Continuallymonitor the cost effectiveness of services provided through the patient's individualized care plans, and recommend any needed changes to those plans based on evidence based clinical guidelines from sources identified by the Practice.
  • Participate in continuing professional growth through attendance of workshops and professional in-services and through individual research and reading, to include communication skills.
  • Participate in population management activities as directed by the Health Center.
  • Attend and participate in organized functions of the Health Center and perform administrative function as necessary.
  • Demonstrate personal responsibility and respect for patients, patients' families, and co-workers in professional appearance.
  • Assist with teaching families and personnel.
  • Perform duties in a manner that is culturally and, if applicable, linguistically appropriate.
  • Demonstrate flexibility, enthusiasm, and willingness to cooperate while working with others in multi-disciplinary teams with activities to include participating in daily huddles.
  • Transitions of care (which may include from Pediatrics to Adults)
  • Performs other related duties as assigned.. Requirements: EDUCATION, TRAINING AND EXPERIENCE
    • Graduated from an accredited school of professional nursing or from a national or state approved school of vocational nursing.
    • Licensed as a vocational nurse in California (LVN) with clinical experience of at least 3 years or a Bachelor's of Science Degree from a 4-year college or university.
    • Health Coach certification and/or motivational interviewing training preferred
    • Demonstrated skills in leadership, advocacy, communication education and counseling
    • Culturally effective capabilities demonstrating a sensitivity and responsiveness to varying cultural characteristics and beliefs
    • Bilingual (defined based on the linguistic and cultural needs of the patient population)KNOWLEDGE, SKILLS AND ABILITIES
      • Ability to find solutions when barriers are identified.
      • Strong documentation skills.
      • Ability to multi-task and prioritize when needed.
      • Ability to independently seek out resources and work collaboratively.
      • Ability to read, understand and follow oral and written instructions.
      • Experience and work ethics that supports working within a high functioning, team-oriented environment.
      • Demonstrates a willingness and ability to work under supervision.
      • Ability to develop and maintain good working relationships with staff.
      • Ability to use computer and learn new software programs.
      • Excellent interpersonal skills reflecting clarity and diplomacy and the ability to communicate accurately and effectively with all levels of staff and management.
      • Demonstrates ability to work in a regulatory climate that includes oversight of state and federal entities, payer contracts etc.
      • Possesses ability to communicate effectively, both verbally and in writing.
      • Possesses genuine respect for others and acceptance of their individual social and cultural traits.
      • Proficient knowledge of Microsoft Outlook.
      • Able to travel and attend professional meetings, conferences, trainings and clinic sites.
      • Demonstrate flexibility, enthusiasm, and willingness to cooperate while working with others in multi-disciplinary teams.
      • Performs other related duties as assigned.PHYSICAL DEMANDSPosition requires prolonged sitting at a computer, some bending, lifting, stooping and stretching. Good eye-hand coordination and manual dexterity sufficient to operate a computer keyboard, photocopy machine, telephone, and other office equipment is also required. Employee must have normal range of hearing and eyesight.NOTE: The essential job functions for this position include, but may not be limited to those listed in this job description. Employees hired for this position must be able to perform the essential functions of this job without imposing significant risk of substantial harm to the health or safety of themselves or others


Keywords: Comprehensive Community Health Centers Inc., Glendale , NURSE CARE COORDINATOR, Healthcare , Glendale, Arizona

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