Care Coordinator I or II

Position Summary :

Full-time position available for our Kent Medical Clinic. The Care Coordinator is responsible for being part of a clinical care team and enhancing quality and patient-centered care.

This is accomplished by assessing gaps in care for patients with chronic conditions and / or mental health needs and creating a plan with the clinical care team during daily huddles.

Will assist patients with medication management, access to insurance, and help identify any other preventive health needs.

Will also assist patients with ongoing self-management goal setting utilizing Motivational Interviewing skills. Strong computer skills are necessary to be able to track patient’s adherence with their plan of care in electronic charts.

This position also requires that the Care Coordinator facilitate team meetings so organization skills and effective communication skills are needed.

Duties and Responsibilities :

• Participate in morning huddles to anticipate the patient’s clinical, social and behavioral health needs.
• Work with the care team to identify gaps in care and work to resolve them using process improvement strategies.
• Provide brief interventions at point of care to assist patients with management of their chronic illness, address any social needs and link patients to behavioral health.
• Advocate for patient services with community, social service, and medical providers.
• Participate and coordinate care transitions for patients who have been seen in an emergency room and / or have been discharged from a hospital / long-term care facility.
• Track patient’s adherence with plan of care in electronic or paper charts and communicate outcomes and recommendations to the primary care provider.
• Function as a point person within the clinic care team regarding chronic disease management and improvement activities to improve clinical quality measures.
• Organize monthly Health Home meetings by working with the Clinic Operations Team / Clinic Manager, create the agenda and help facilitate the meeting.
• Collaborate with clinical care team to improve Patient-Centered Medical Home processes and provide documentation demonstrating performance.
• Review the medical record for quality and utilization indicators according to the Quality Improvement Plan.
• Generate reports for care teams to identify areas of improvement and monitor sustainability of each quality measure.

Other duties assigned as needed.

Qualifications and / or Experience :

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and / or ability required.

Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

• Must be able to work independently, prioritize workload, and meet deadlines.
• Must have critical thinking skills and maintain confidentiality.
• Excellent organizational skills and ability to handle a variety of tasks simultaneously.
• Knowledge of medical terminology and / or behavioral health topics.
• Strong decision making and prioritization skills.
• Ability to work respectfully and professionally with the community, patients, families and staff.
• Able to work effectively in a multi-cultural environment with a diverse population.
• Sympathetic, mature, responsible, and reliable.
• Strong patient engagement, interpersonal, and communication skills and ability to establish a therapeutic relationship with the patient.

Knowledge, Skills, and Abilities

• Knowledge of the Patient-Centered Medical Home Model and motivational interviewing skills a plus.
• Knowledge of evidence-based standards of care for chronic conditions and behavioral health issues.
• Knowledge of and proficient in Microsoft Word, Excel, PowerPoint, and Outlook.
• Ability to utilize and document relevant patient information the Electronic Health Record.
• Knowledge of community resources.
• Ability to work in a fast-paced community health care setting.
• Ability to think analytically and problem solve in a multidisciplinary team and independently.
• Ability to deal effectively with difficult people and situations.
• Ability to communicate effectively with diverse communities.
• Ability to manage time effectively and prioritize tasks.
• Ability to analyze patient care data.
• Ability to identify client learning needs and to assess client's knowledge, skill level and readiness for learning.
• Ability to maintain the privacy and security of sensitive and confidential information in all formats including verbal, written and electronic;

and adhere to policies and procedures related to local, state, and federal privacy requirements.

• Excellent communication and customer service skills.
• Critical thinking skills.
• Ability to understand and implement process improvement activities.
• Bilingual in Spanish is strongly preferred. Other language skills may be considered depending on site needs due to the population that is being served.

Education, Certificates, Licenses, and Registrations

For Care Coordinator I, must have Medical Assistant Training with one or more years of experience in a community health setting or family practice, or, one or more years of equivalent experience.

Current licensure is not required for this position.

For Care Coordinator II, must be an LPN with experience in ambulatory care and / or have a BA / BS / BSW in health-related field with one year of experience working in community health, or, 4 years of equivalent experience.

The LPN does not have to have an active license; this is a non-licensed position.

• This position must obtain CPR within 90 days of hire date and is required to maintain current CPR throughout employment.
• NCQA (National Committee for Quality Assurance) Certification is a plus.
• Valid WA State Driver’s License and proof of liability insurance.

What We Offer :

Sea Mar offers talented and motivated people the opportunity to work in a dynamic and growing community health organization.

Working at Sea Mar Community Health Centers is more than just a job, it’s a fulfilling career with opportunity for advancement.

The fringe benefits surpass most companies. For example, Full-time employees working 30 hours or more, receive an excellent benefit package of :

• Medical
• Dental
• Vision
• Prescription coverage
• Life Insurance
• Long Term Disability
• EAP (Employee Assistance Program)
• Paid-time-off starting at 24 days per year + 10 paid Holidays.

We also offer 401(k) / Retirement options and an exciting opportunity to work in a culturally diverse environment