Care Coordination Specialist for High-Risk Patients

Northwell Health; Manhasset (NY); On-site; USD 60,000 - 85,000; Full time

Job summary

Northwell Health in New York is seeking a Care Manager to coordinate care for patients and families, using patient-centered motivational interviewing to build rapport and motivate health improvements. The role supports primary care teams in panel management and developing individualized care plans for high-risk patients.

You will liaise with hospitals, PCPs, specialists and community resources to ensure coordinated, patient-centered care.

Qualifications

• High School Diploma or equivalent required.
• 1-3 years of relevant experience, required.
• Bachelor's or Master's degree in relevant field strongly preferred.
• Health home or care management experience strongly preferred.
• NYS Driver's License strongly preferred.
• Bilingual Spanish, preferred.

Responsibilities

• Uses patient-centered motivational interviewing techniques to build rapport and help patients improve their health.
• Supports the primary care team by providing panel management to decrease the number of patients lost to care and non-compliant in follow up care; participates in development and maintenance of individualized care plans for high-risk patients.
• Acts as a professional liaison between hospitals, primary care providers, specialists, and community resources on behalf of patients to ensure patient-centered care coordination.
• Identifies and tracks special populations, including high-risk patients and other populations due for preventive or chronic care services.
• Identifies and tracks patients discharged from the inpatient service or the emergency department.
• Uses team-based communication strategies to close the loop on referrals and hospital follow-ups; performs outreach in primary care sites, homes, hospitals, and neighborhoods.

Skills

1-3 years experience

Care management experience

NYS Driver's License

Bilingual Spanish

Education

High School Diploma or equivalent

Bachelor's or Master's degree preferred

Job description

Northwell Health in New York is seeking a Care Manager to coordinate care for patients and families, using patient-centered motivational interviewing to build rapport and motivate health improvements. The role supports primary care teams in panel management and developing individualized care plans for high-risk patients.

You will liaise with hospitals, PCPs, specialists and community resources to ensure coordinated, patient-centered care.