Care Support Coordinator I or II

Would you like to have a career that makes a daily difference in people’s lives? Do you want to be part of a caring, respectful, diverse community? If you answered yes to these questions, keep reading!

HealthPoint is a community-based, community-supported and community-governed network of non-profit health centers dedicated to providing expert, high-quality care to all who need it, regardless of circumstances. Founded in 1971, we believe that the quality of your health care should not depend on how much money you make, what language you speak or what your health is, because everyone deserves great care.

Position Summary:

The Care Support Coordinator works within an integrated primary care team to provide longitudinal coordination of healthcare, social services, and supports with the goal of improving the overall health, wellness, self-management, and wellbeing of populations of patients. The Care Support Coordinator works closely with agencies and individuals to improve access to and utilization of medical, social, and behavioral health resources by assessing a person’s needs, helping them set goals and achieve them over time.

Compensation is dependent on skills and experience.

Your contribution to the team includes:

• Provide coordination of healthcare and social services by initiating, developing, implementing, and maintaining an individualized care plan to guide patients toward achieving self-identified health and life goals. Routinely reassess progress toward these goals and document in necessary electronic systems. Actively engage and support patients with a focus on individuals at high risk for poor health outcomes or avoidable high-cost care.
• Evaluate, assess, triage, refer and support patients with various medical, behavioral health and social conditions by actively partnering with interdisciplinary care teams, focusing on overcoming social drivers of health and improving health equity.
• Actively maintain engaged patient panel utilizing proactive person-centered techniques and approaches such as critical thinking, motivational interviewing, case finding, SMART goal setting, health coaching, patient-empowerment, relationship-building and proactive independent collaboration.
• Be committed to a continuous learning environment where programmatic goals will shift based on the healthcare landscape, requiring flexibility and prioritization. Provide care coordination support for patients in various programs including pilot projects, grant-funded initiatives or other populations as identified in collaboration with leadership. Travel to various locations including clinic, community, and home visits to provide care and support as needed.
• Provide intake and longitudinal care management services to identified patients including transition of care support, housing and resource navigation, community resource procurement, care coordination, and emotional support. Evaluate acuity of needs and assist patients in overcoming barriers to optimal health and wellness, promoting graduation from care coordination when appropriate and maintaining appropriate patient panel size.
• Effectively collaborate with diverse care team members, including community partners and external organizations to promote health, wellness, effective coping and disease management for designated populations. Foster efficient delivery of care and services by facilitating effective communication and coordination between patients, their support system, and care teams. Respond to patient and care team requests promptly.
• For patients eligible for specific programs through their insurance carrier or public or private funders, including Health Homes or Medicaid, provide care and services in line with the requirements of the managed care organization, external entity, or funder. Complete any payer contract requirements including eligibility verification, coordination of appointments, attending required trainings, and administering and documenting patient screenings or assessments within required timeframes.
• Promote patient self-management, self-determination, and person-centered care by functioning as an ambassador for services within HealthPoint and the community. Develop skills to encourage care team collaboration and efficiency, including: facilitate care conferences, identify needs and connect to other interdisciplinary team members or specialties to support high quality patient care.
• Maintain professional relationships and boundaries while supporting patients, families or caregivers with empathy, compassion and cultural congruence and maintaining respect for confidentiality, privacy, and mandated reporting.
• Identify and take appropriate action on patient safety situations, including providing real-time connections to necessary supports utilizing HealthPoint safety protocols, and state and local guidelines. Utilize leadership support when indicated.
• Actively participate in population health approaches to patient care and support. Gain understanding of data analysis and contribute to understanding health and social outcomes for patients, communities and within the care team.
• Assess and utilize appropriate communication modalities to maintain consistent connection with patients, families and care team members including phone calls, video visits, clinic or home visits, and electronic communications as appropriate. Display emotional intelligence and continuously develop communication skills.
• Document appropriately and timely in electronic medical record, databases, and other electronic systems as indicated. Demonstrate efficient and effective approaches to managing workload.
• Maintain good attendance and punctuality.
• Demonstrate respectful, professional, and appropriate behavior that supports a team-oriented work environment.
• Demonstrate a commitment to the mission, core values and goals of HealthPoint and its healthcare delivery including the ability to integrate values of justice, respect, compassion, excellence and stewardship into appropriate programs and services.
• Other duties as assigned by leadership.
• Attend staff meetings, in-service meetings and participate in agency committees and task force activities as required.

Care Support Coordinator I:

• Develop and implement patient-engagement skills to positively impact quality metrics, program, and clinical outcomes with designated patients. Be accountable for improving health outcomes, utilization rates, patient satisfaction, and self-sufficiency for a defined population of patients in alignment with evolving organization and population health goals for people with various medical, behavioral health and social situations.
• Gain understanding of the biopsychosocial perspective to administer screenings and provide referrals for various risk factors or conditions to help guide and inform care plan and care support interventions or approaches such as PRAPARE, PHQ-9, GAD-7, KATZ, or PAM.
• Bachelor’s Degree in Social Work or related field (BA/BS) preferred, and at least 1 year of relevant work or clinical experience, or an equivalent combination of education and experience required.

Care Support Coordinator II:

• Utilize patient-engagement skills to positively impact quality metrics, program, and clinical outcomes with designated patients. Be accountable for improving health outcomes, utilization rates, patient satisfaction, and self-sufficiency for a defined population of patients in alignment with evolving organization and population health goals for people with complex medical, behavioral health and social situations.
• Utilize the biopsychosocial perspective to administer screenings and assessments. Provide referrals for various risk factors or conditions to help guide and inform care plan and care support interventions or approaches such as PRAPARE, PHQ-9, GAD-7, KATZ, or PAM.
• Bachelor’s Degree in Social Work or related field (BA/BS) preferred, and at least two (2) years of relevant work experience or equivalent combination of education and experience required. Bilingual language proficiency preferred. Previous experience in a clinic or hospital setting, working with vulnerable populations, or community health required.

Must have’s you’ll need to be successful:

• Valid Washington State Driver’s License with an acceptable driving record determined by HealthPoint’s insurance carrier.
• This position requires the delivery of services and support in a variety of settings including clinics, administrative offices, community environments, and patient homes. Reliable transportation and willingness to travel to various locations required.
• 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.
• Ability to read and interpret technical and other complex documents. Ability to write routine correspondence such as letters and memos. Ability to present information in one-on-one and small group situations to internal and/or external clients.

If you know about the following it’s a plus:

• Bilingual language proficiency preferred. Previous experience in a clinic or hospital setting, working with vulnerable populations, or community health preferred.
• Possesses basic operating knowledge of computers. Comfortable with Word, Excel and Outlook required, willing to learn OTTO or any other electronic telehealth platform. Electronic Health Record experience preferred.

Proof of vaccination for COVID-19 is required, prior to start. HealthPoint does not accept the Johnson & Johnson COVID-19 vaccine as proof of vaccination. If you have received the Johnson & Johnson vaccine, we ask that you provide documentation demonstrating proof of an alternate COVID vaccine or vaccine series. All new employees are also required to show proof of immunizations and/or immunity to MMR (measles, mumps, rubella), Varicella, annual Influenza and TB QuantiFERON Gold Titer. Additionally, if you work in a HealthPoint clinic, Tdap (within last 10 years) is required. Hepatitis B. is required for clinical employees with potential exposure to blood/blood products. All immunizations are a condition of employment. Upon hire, employees must provide proof of their immunizations and/or immune titer results prior to starting or no later than their fifth (5) business day of employment.

Where to gather your records:

• If you are providing immunizations from an electronic health record, please ensure that you obtain a copy of your full records rather than a screenshot. Each page of your records should include your first and last name, date of birth, and the name of the health system from which the records are pulled.
• If records do not show any data, please seek guidance from your provider for further assistance.
• If you are unable to provide proof as noted above, you can choose to have a lab titer drawn to check immunity or to be re-vaccinated. If you receive vaccination(s) or lab titers, you may obtain them through HealthPoint at no cost to you. This is a great opportunity to get your immunization record up to date at no additional expense.

HealthPoint is committed to offering all employees a competitive compensation package, including benefits and several other perks.

• Medical, Dental, and Vision for employees and their families/dependents
• HSA, FSA plans
• Life Insurance, AD&D and Disability Coverage
• Employee Assistance Program
• Wellness Program
• PTO Plan for full-time benefited and part-time benefited employees. 0-.99 years of service accrual of 5.23 hours per pay period. (pro-rated accruals for part-time benefited employees)
• Extended Illness Time Away of 40 hours (pro-rated for part-time benefited employees)
• 8 holidays and 3 floating holidays
• Compassion Time Away up to 40 hours
• Opportunity Time Off (extended time off for staff to invest in themselves) up to 8 weeks
• Retirement Plan with Employer Match
• Voluntary plans at a discount, such as life insurance, critical illness and accident insurance, identity theft insurance, and pet insurance.
• Development and Growth Opportunities

To learn more about HealthPoint, go to www.healthpointchc.org! #practiceyourpassion

It is the policy of HealthPoint to afford equal opportunity for employment to all individuals regardless of race, color, religion, sex (including pregnancy), age, national origin, marital status, military status, sexual orientation, because of sensory, physical, or mental disability, genetic information, gender identity or any other factor protected by local, state or federal law, and to prohibit harassment or retaliation based on any of these factors.