Care Coordinator I (ICP)

Innovation Care Partners – 8901 E Mountain View Rd, Scottsdale, AZ 85258 Category: Healthcare Support Shift: Day Department: Care Management Schedule: Mon-Fri 8:00–4:30, Weekend Rotation Required Job Summary The Care Coordinator I collaborates with the primary physician and other healthcare team members to develop patient-centered goals and actions, ensuring the formulation of a realistic and definitive goal that represents the total care needs and resources of the patient/client and family. The Care Coordinator acts as patient advocate through the continuum and is available to the physician, patient and family as a resource to facilitate communication. They provide coaching and care coordination to assigned patients to ensure effective transitions as patients move through the health care continuum to include ambulatory care, hospital, home environment, and skilled nursing facilities. They serve as an embedded care resource with a focus on the health, wellness, and care coordination needs of the patient population. Essential Functions Coaches and guides patients and their caregivers in addressing critical issues and self-management tasks, utilizing active listening, Behavioral Motivational Interviewing, guided care goal setting, and home visits to ensure face-to-face communication and relationship building. Ensures accurate and complete documentation for every patient encounter. Coordinates and reviews patients’ progress with clinical practitioners such as home health RNs, doctors, physician assistants, etc., striving to meet goals of educating and empowering patients and caregivers to prevent additional resources and possible hospital admissions. Performs outbound calling, home visits, and appointment scheduling as necessary. Assists patients with medication reconciliation, coordination of post-discharge home care needs, self-management support, follow-up care, supportive care, advanced care planning, community resources, and long-term planning needs. Reports patients’ compliance/non-compliance with medical care instructions to appropriate clinical staff. Communicates professionally using all modalities (email, technology, written, and verbal) with clinical team, patients, and caregivers in a clear and concise manner. Ensures safe handoff of care for hospitalized/post-acute care patients from Transitional Care Managers to Care Coordinators. Coordinates follow-up care with PCPs and specialists regarding outpatient appointments and plans of care. Coordinates care with internal and external providers and healthcare team members involved in the care. Builds and maintains working relationships with patients, caregivers, and other health care partners. Maintains and manages caseloads independently with minimum direction, anticipating and organizing workflow, working with a high-volume caseload, and dealing with rapidly changing priorities. Collaborates with HonorHealth staff, social service organizations, and community resources as needed to meet each patient’s needs. Maintains knowledge of applicable laws, regulations, Medicare, Medicaid, SSI, and SSDI benefits. Performs other duties as assigned. Education High School Diploma or GED – Required Associate’s degree in Business, Health Administration, or related field – Preferred Experience 1 year outpatient, ambulatory care, specialty care, or community healthcare experience – Required 2 years in outpatient clinical setting working with PCPs; home care experience; preference given to honorably discharged veterans – Preferred License and Certifications Basic Life Support (BLS) certification, CPR Card – Required Fingerprint Clearance Card (FPC) – Must be a current State of Arizona Fingerprint Clearance Card within 8 weeks from date of hire for employees conducting home visits – Required Emergency Medical Technician – Basic (EMT) license; MA, EMT, Paramedic BLS, or equivalent military experience – Preferred #J-18808-Ljbffr