Care Coordinator-Non Clinical

Job description

The Care Coordinator works with the Delaware Valley primary care medical homes, utilizing a team based, family centered approach, in continuous partnership with families and physicians to promote: timely access to needed care, comprehension and continuity of care, and the enhancement of child and family well-being. The Care Coordinator addresses gaps in care and promotes timely access to appropriate care, increasing the utilization of preventative care and healthy behaviors to improve the health of the population at risk. Responsibilities: Assist with, and/or promote, the identification of patients in the practices with special health care needs by reviewing appropriate registry reports. Monitors chronic/preventive patient registries/lists and Gap in Care reports to assist in getting patients the appropriate appointments and/or interventions. Initiate family contacts; create ongoing processes for families to determine and request the level of care-coordination or care management support they desire for their child/youth or family member at any given point in time. Identify patient and family needs and unmet needs, strengths and assets. As a member of the care team, monitor patient...