Care Coordinator (RN Health Coach)

RN Health Coach/Care Transitions Coach

This role is responsible for assessing the needs of individuals and coordinating services to support their health, safety, and independence. This role involves developing care plans, connecting clients with community resources, and advocating for their well-being while collaborating with families and service providers.

Primary Responsibilities

• Conduct in-home assessments and event-based visits.
• Conduct comprehensive assessments of an individual’s physical, emotional, social, and environmental needs.
• Complete medication reconciliations.
• Provide chronic disease education and coaching.
• Develop and implement individualized care plans based on client needs, preferences, and available resources.
• Coordinate and monitor services such as home care, transportation, meals, housing, and medical appointments.
• Provide ongoing case management, including regular follow-ups, plan adjustments, and crisis intervention as needed.
• Advocate for clients’ rights and ensure they receive culturally competent, person-centered care.
• Maintain accurate and timely documentation in accordance with agency and regulatory requirements.
• Support clients and their families in understanding available options and navigating complex service systems such as Medicare and Medicaid.
• Participate in team meetings, training, and professional development opportunities.
• Adhere to program contact and visit schedule.

Minimum Requirements:

• RN Ohio licensure
• Valid driver’s license with reliable transportation and proof of insurance

Preferred Requirements:

• 5 years of clinical experience (hospital or home health)
• Bachelor's degree

Skills:

• Experience completing home visits.
• Experience connecting individuals to resources and services.
• Strong attention to detail and time management.
• Excellent time management skills to balance home visits and documentation timelines.
• Proficiency using electronic health records.
• Accurately maintain case notes and client records.
• Active listening with empathy and support to our clients.
• Cultural competencies to support clients from diverse backgrounds.
• Knowledge of community resources.
• Passionate about working with older adults and those with disabilities.

Working Conditions

• Care Coordinators fluctuate between out in the field conducting home visits and in a traditional office setting to complete the documentation and care plan follow-ups.
• Desks will be assigned to new staff during the training period. Some programs may require desk sharing, docking, or remote work after training.
• Up to 24-hours of weekly telework may be available following the initial training period with supervisor approval.
• Staff must use personal vehicles.

Reasonable Accommodation Statement

COAAA is committed to providing equal employment opportunities to all individuals, including those with disabilities. In accordance with the Americans with Disabilities Act (ADA), we will provide reasonable accommodations to qualified individuals with disabilities to enable them to perform the essential functions of the position. If you require an accommodation during the application or employment process, please contact HR@COAAA.org.

Equal Employment Opportunity Employer

COAAA empowers staff to reach their full potential in an environment that embraces each person’s skills and unique experiences in order to provide the best quality customer service possible. We are a compassionate, community-minded team that aspires to provide excellence in service to our neighborhoods.