CHT Care Coordinator

Job Description

Job Description

JOB SUMMARY : As a member of the Community Health Team, the Dietitian Care Coordinator works with patients to identify their health goals and together with their practitioners create a care plan that will support them in achieving their goals. The Dietitian Care Coordinator provides healthy lifestyle counseling , medical nutrition therapy for chronic conditions, and / or short-term case management for high-risk, socially and medically complex patients. This role helps identify and manage unmet needs of the patients to ensure appropriate resources are in place to improve health outcomes.

FUNCTIONS and RESPONSIBILITIES

• FUNCTIONS and RESPONSIBILITIES

Provides patient and family education and support in removing barriers to achieve wellness and management of chronic conditions, provides patients / families with educational materials for self-management that are both paper and web-based.

Will perform duties within scope of practice per license and follow standards of practice as outlined by, but not exclusive to :

The Commission on Dietetic Registration for Registered Dietitians.

May use reports or reporting systems to identify high-risk patient populations.

Actively participate in multiorganizational care teams and case reviews to provide patients with wrap-around care coordination through diverse community resources.

Meets with patients to assess and identify any unmet health needs.

Attends mandatory staff meetings and committee meetings as deemed appropriate by Director of Community Health Integration.

Participates in Patient Centered Medical Home (PCMH) accreditation process.

Has a working knowledge of clinical systems.

QUALIFICATIONS

Nutritionist and / or Diabetes Educator

At least two years of experience as a dietitian providing nutrition education, ideally in a healthcare setting

Must maintain a high level of confidentiality