The Community Care Coordinator plays a vital role in facilitating and coordinating healthcare services for individuals within the community. The purpose of this role is to connect patients with the appropriate resources, coordinate care plans, and ensure seamless transitions between healthcare providers to promote optimal patient outcomes and enhance community health.

• Tasks (Including but not limited to)
• Assessing the healthcare needs of individuals within the community and identifying gaps in care.
• Collaborating with healthcare providers, social service agencies, and community organizations to develop comprehensive care plans for patients.
• Assisting patients in navigating the healthcare system and accessing necessary services, such as medical appointments, specialist referrals, diagnostic tests, and community resources.
• Coordinating and scheduling appointments for patients with multiple healthcare providers to ensure continuity of care.
• Facilitating communication and information exchange between patients, healthcare providers, and other stakeholders involved in the care process.
• Monitoring patients' progress and adherence to care plans, providing support and education to promote selfmanagement and preventive care.
• Conducting home visits or outreach activities to assess patients' living conditions, social support systems, and adherence to treatment plans.
• Advocating for patients' needs and rights within the healthcare system and community resources.
• Documenting patient interactions, care plans, and progress notes in electronic health records or care management systems.
• Participating in interdisciplinary team meetings and case conferences to ensure effective coordination and collaboration among healthcare professionals.
• Ensuring members/patients are transported to appointments or other locations as necessary, using Employee’s personal vehicle. (Mileage is reimbursed with company policy rates)
• Additional duties as assigned
• Qualifications

Education and Experience

• 23 years in a health care setting, preferably in mental health. 3+ years preferred but not necessary.

Education

• Bachelor's degree in social work, SUDC, ASUDC, QMHP, MA, CNA or related

License, Certificate, or Registration

• CPR/First Aid
• Skills
• Comprehensive knowledge of healthcare systems, community resources, and social services available to support patient care.
• Strong interpersonal and communication skills to establish rapport with patients, families, and healthcare providers.
• Excellent organizational and time management skills to manage multiple patients and coordinate care effectively.
• Ability to assess patient needs, develop individualized care plans, and evaluate outcomes.
• Proficiency in using electronic health records and care management software.
• Understanding of privacy regulations and compliance requirements related to patient information and data security.
• Compassionate and patientcentered approach to care, with a commitment to advocating for vulnerable populations.
• Problemsolving and critical thinking skills to address barriers to care and resolve complex situations.
• Cultural competence and sensitivity to diverse populations and their unique healthcare needs.
• Ability to work collaboratively in a team and maintain positive relationships with healthcare professionals and community partners.