Community Care Coordinator (LA - East Baton Rouge Parish)

Community Care CoordinatorAdobe Population Health (APH) is a women-owned health solutions company founded in 2018 with a mission of positively impacting the lives we touch. Headquartered in Phoenix, AZ, with satellite locations across multiple states, APH fosters a culture rooted in inclusivity, human kindness, and high-quality care.Recognized by Inc. 5000 as one of America’s Fastest-Growing Private Companies and honored for a fifth consecutive year as a “Best Place to Work” by the Phoenix Business Journal, APH continues to expand its reach and impact.APH partners with health plans, providers, hospitals, and families to deliver tailored programs including case management, in-home and in-clinic wellness assessments, preventative care, transitional care, and social services. As one of the nation’s few fully integrated healthcare organizations, APH delivers comprehensive, coordinated medical and social support through a wide range of specialized service lines.With continued growth on the horizon, APH is seeking mission-driven individuals who are passionate about improving health outcomes and supporting those in need.Position PurposeThe Community Care Coordinator is responsible for providing comprehensive care coordination and management services to clients within an assigned territory. This role combines field-based care coordination with supervisory responsibilities, focusing on enhancing client outcomes through behavioral, physical, and social interventions. As a CCC, you will oversee case management activities, ensure compliance with organizational policies, and foster positive relationships with clients, caregivers, providers, and team members. Additionally, you collaborate with healthcare providers, social services, and community organizations to identify and address barriers to health and well-being. The ideal candidate will be passionate about community engagement and equity, and skilled in connecting individuals with appropriate resources that improve their health outcomes.This position requires travel across Baton Rouge, throughout East Baton Rouge Parish, and surrounding areas to provide in-home support to our members.Duties & ResponsibilitiesResource Sharing and Care CoordinationProvide field-based care coordination to address behavioral, physical, and social needs of assigned clients, aiming to reduce medical costs and improve quality of life.Assess the social, financial, and health needs of individuals and families within the community.Connect clients with appropriate services, including housing assistance, food security programs, healthcare services, transportation, and mental health resources.Develop and implement individualized care plans in collaboration with clients, ensuring that their unique needs are addressed.Provide ongoing support to ensure clients' needs are met, including follow-ups and reassessments.Advocate on behalf of clients to ensure they receive timely access to services and resources.Health Education and SupportOffer education on physical health, illnesses, treatments, dietary concerns, stress management, and safe medicine use.Provide emotional support to clients and manage their overall well-being.Support clients in developing self-care strategies and accessing preventive health services.Encourage clients to actively engage in their health and well-being through empowerment and education.Transition of Care and Follow-UpCoordinate services with members transitioning from a hospital setting.Support hospital-based member visits.Provide transitional care coordination efforts.Ensure member follow-up post discharge.Monitor member vitals.Assist in care gap closure during member interactions.Community Outreach and EngagementConduct home safety evaluations and monitor client progress through regular home visits.Connect clients with appropriate community services and resources.Build and maintain strong relationships with local community organizations, healthcare providers, and government agencies to ensure access to a wide range of resources.Participate in outreach efforts to identify individuals and families in need, particularly in underserved or marginalized communities.Represent the organization at community events, health fairs, and workshops to promote services and educate the public about available resources.Identify trends and emerging needs within the community to inform organizational planning and service delivery.Data Collection and Record KeepingMaintain accurate records of care coordination in the Electronic Medical Record (EMR) system and ensure compliance with HIPAA regulations.Document interactions, care plans, and outcomes in accordance with organizational policies and confidentiality guidelines.Track and report on the effectiveness of referrals and interventions to help identify gaps in services or areas for improvement.Maintain accurate records of client information and provide timely reports to supervisors and funding agencies as required.Participate in program evaluation and quality improvement initiatives.Policy and Procedure ComplianceEnsure adherence to Adobe policies and procedures, and assist in developing and updating company programs, policies, and procedures as needed.Relationship BuildingDevelop and maintain positive relationships with case managers, providers, administration, and other stakeholders.Travel and MeetingsTravel to assigned territories for training, meetings, and as requested by upper management. Attend all applicable facility and management meetings.Other DutiesCompletes other duties and responsibilities as assigned.Skills & QualificationFour (4) plus years of related experience and/or training, or an equivalent combination of education and experience.Medical experience strongly preferred.Experience working with diverse populations, including marginalized, low-income, and underserved communities.Must have the willingness to drive with a clean driving record.Reliable transportation.Clean driving record.Excellent communication skills, both verbal and written.Requires problem-solving and decision-making.Must be able to work in a self-directed environment.Identify and resolve problems in efficient and effective ways.Takes personal responsibility for the quality and timeliness of work and achieves results with little oversight.Adapts to changing business needs, conditions, and work responsibilitiesProficiency in Microsoft Office Suite.Knowledge of confidentiality and data protection regulations, especially in relation to health information (e.g., HIPAA compliance).Bilingual (Spanish/English) preferred.Education, Licenses, & CertificationsAssociate’s degree in Social Work, Sociology, Psychology, Counseling, or a related field required, OR active LPN/RN licensure, EMT, or Paramedic certification.Bachelor’s degree preferred.Current BLS certification and annual TB testing required.Current and clear driver’s license.Current auto insurance.Benefits & Total RewardsPaid Orientation and TrainingInsurance – Medical, Dental, Vision, and Life401k Plan – 3% matchEmployee Assistance ProgramTuition ReimbursementContinued Education SupportMileage Reimbursement (if applicable)Referral BonusesPaid Holidays (9 days)Paid Time Off (15 days)Paid Volunteer HoursCharacter & CompetenciesDiversity - Demonstrates knowledge of EEO policy; Shows respect and sensitivity for cultural differences; Educates others on the value of diversity; Promotes a harassment-free environment; Builds a diverse workforce.Ethics - Treats people with respect; Keeps commitments; Inspires the trust of others; Works with integrity and ethics; Upholds organizational values.Adaptability - Adapts to changes in the work environment; Manages competing demands; Changes approach or method to best fit the situation; Able to deal with frequent change, delays, or unexpected events.Customer Service - Manages difficult or emotional customer situations; Responds promptly