Care Coordinator, Patient Centered Care

Job description

The Care Coordinator, in collaboration with Thresholds Community Support teams and Patient Centered Care (PCC) Wellness Clinics, provides care coordination, case management and linkage for Thresholds members who are also receiving care at PCC clinics, to resources designed to improve social determinants of health, with an emphasis on those who are Medicaid eligible under the Affordable Care Act, and need assistance with maintaining Medicaid coverage and access to care. The Care Coordinator assists Thresholds Community Support teams and PCC in implementing program improvements that strengthen care management, member access, and health outcomes. This role is responsible for developing and maintaining data tracking and reporting in alignment with the Mental Health Expansion Initiative grant. Position reports to either Assistant Program Director or Program Director. ESSENTIAL DUTIES & RESPONSIBILITIES: - Reports to the Program Director and works in collaboration with the Assertive community Treatment (ACT), Community Support Team (CST), and Community Support Individual (CSI) teams to coordinate healthcare with PCC and maintain Medicaid eligibility. - Attends team and program meetings....