November 19, 2024

Green Tree Home Care

Santee

FULL TIME

Care Coordinator (Enhanced Care Management) hybrid remote

About Us: Green Tree Wellness, a subsidiary of Green Tree Home Care, is a leading healthcare organization dedicated to providing comprehensive and compassionate care to our community. Our mission is to provide person-centered case management and supportive services that create opportunities for underserved, lower-socioeconomic and homeless families and individuals to rapidly return to stable lives and long-term self-sufficiency through people centered care management ranging over a broad range of covered services. We aim to bridge the gaps between the interdisciplinary team in order to empower patients to lead healthier happier lives. As we continue to grow, we are seeking a highly motivated, organized, and compassionate Care Coordinator with lived and or professional experience to join our Enhanced Care Management team. The Care Coordinator will be the center of a larger interdisciplinary group and work together as a team to facilitate the planning and organizing of all critical activities for our patients bridging the gap between providers, community supports, and our members. The patients we care for are some of the most complex patients and need an excellent care team to help manage their chronic conditions.
Position Overview: As a Care Coordinator for Enhanced Care Management, you will play a vital role in ensuring the delivery of high-quality, thorough, compassionate and patient-centered care. You will work closely with management, teammates, healthcare professionals, patients, caregivers and their families to coordinate and optimize the care experience. The ideal candidate will possess knowledge and or lived experience of the management of issues related but not limited to; homelessness, physical and mental health, co- occurring comorbidities and marginalized populations.
Responsibilities:

Data Collection, Outreach to patients, receiving in and completing outward calls
Health Risk Assessment: Conduct recurring comprehensive assessments of patients' medical, social, and psychological needs to develop individualized care plans that include SMART goals, demographics, care planning, ect.
Care Coordination: Collaborate with healthcare professionals, including physicians, nurses, social workers, medical offices, and post hospitalization case managers to integrate and manage the delivery of care services.
Advocacy: Advocate for patients to ensure they receive appropriate and timely healthcare services, including referrals to specialists, diagnostic tests, and other necessary interventions.
Communication: Maintain open and effective communication with patients, their families, management and the healthcare team to facilitate seamless care transitions and improve overall care coordination. This role is about working with the members and other community resources to improve the health and wellness of the members.
Documentation: Accurately document patient assessments, care plans, and interventions in accordance with organizational policies and regulatory requirements. Needs to be able to keep detailed records. Including internal records such as excel trackers, organized calendars, activity logs, and clear concise open communication via email and on our EHR.
Utilization: Identify and connect patients with community resources and support services to enhance their overall well-being.
Willingness to travel: Will receive mileage reimbursement for in person visits that begin and end from and to the office CC is based out of. CC Will be required to do a minimum of 12 in person visits each month to meet members where they are at in the field. Will be based out of the Riverside office in a hybrid role consisting of office and field work, there will be opportunity to be hybrid remote if agreed upon based on territories covered as assigned by management.
Dual Language: this is a big plus, in fact any second language skills are a priority.

Daily activities may include:

Facilitates Transition of Care: The ECM care coordinator ensures a smooth transition for each patient from the hospital back to their Primary Care Physician.
Monitors High-Risk and Under-Utilizers: They keep an eye on high-risk/high utilizers of care as well as under-utilizers of care.
Population Health Monitoring: The coordinator monitors population health related to disease management and helps patients set realistic health goals.
Preventative Health Education: They facilitate preventative health measures and educate patients on preventive health practices.
Risk Management Assessment: The ECM care coordinator assists the Quality Improvement Committee in assessing risk management issues involving patients.
Outreach Events: Will be required to network within the community including growing our network of community supports providers, attending conferences, participating in GAIN, and other outreach events.

Qualifications:

at least 1-2 years of Previous experience in care coordination, case management, or a related healthcare role.
Strong interpersonal and communication skills.
Ability to work collaboratively in a team-based environment.
Excellent organizational and time management skills.
Education: A bachelor’s degree in nursing, healthcare management, or a related field is often required, will consider those with 5+ years of lived experience
Relevant experience in healthcare coordination, case management, or care coordination is essential, only to be superseded by lived experience of 5+ years
Certifications: Certifications such as Certified Case Manager (CCM) or Certified Professional in Healthcare Quality (CPHQ) can enhance candidacy.
Skills: Strong communication, organizational, and problem-solving skills are crucial.
Familiarity with electronic health records (EHRs) is beneficial, particularly Sales Force.
Knowledge: Knowledge of healthcare systems and community resources, understanding of healthcare regulations, patient care pathways, Knowledge of Populations of Focus including but not limited to SMI, SUD, Homelessness, Youth and Children, Transitioning from Incarceration etc. and population health management is valuable.
Must have car with insurance, must be willing to drive within IE and San Diego counties
Must have computer literacy, knowledge of 365 applications and use.
Must be willing to drive to Riverside office minimum of 2 times a week.

How to Apply: Interested candidates are invited to submit their resume and cover letter to hiringrs@greentreehomecare.com. Please include "Care Coordinator Application - Enhanced Care Management" in the subject line.
Green Tree Home Care is an equal opportunity employer. We encourage candidates from diverse backgrounds to apply.
Join us in making a positive impact on the lives of our patients through enhanced care management!
Job Type: Full-time
Pay: $22.00 - $30.00 per hour
Expected hours: 40 per week
Benefits: