Care Coordinator - Marietta

Fortis-Care; Marietta (GA); Hybrid; USD 48,000 - 64,000; Full time

Benefits offered by this job

Health reimbursement account

401(k) plan

Paid vacation

Paid sick time

No weekends

Family-friendly

Job summary

Fortis Care is seeking a Care Coordinator to support patients with complex medical needs under the supervision of the Manager, Chronic Care Management. You will work directly with patients, providers, and care teams to ensure coordinated, patient-centered care with a focus on engagement, care planning, and follow-up to prevent hospitalizations.

The role emphasizes collaboration with providers and families to develop and update individualized care plans, perform assessments, and ensure accurate

Qualifications

• Must be a Licensed Practical Nurse (LPN) or Certified Medical Assistant (MA).
• 1–2 years of experience in chronic care management, primary care, ambulatory care, skilled nursing, or hospital settings.
• Associate’s degree or higher in a clinical or health-related field preferred.
• Preference given to those with skilled nursing setting experience.

Responsibilities

• Deliver chronic care management services to patients with complex or high-risk conditions.
• Conduct assessments of medical, educational, and psychosocial needs using standardized tools.
• Collaborate with providers, specialists, and families to support development of individualized care plans.
• Identify and prioritize patients for medical services daily, prep charts for efficient visits.
• Provide patient and family education focusing on self-management and self-care.
• Coordinate care transitions, including post-hospital follow-up and medication reconciliation.
• Document all care management activities accurately and timely.
• Participate in process improvement and quality initiatives.

Skills

Chronic disease mgmt

Communication skills

Empathy & patient engagement

Organizational skills

Independent collaboration

Education

Associate degree or higher in clinical/health field

Tools

EHR systems experience

Job description

What You’ll Be Doing

The Care Coordinator plays a key role in supporting patients with complex medical needs. Working under the supervision of the Manager, Chronic Care Management, you will work directly with patients, providers, and care teams to ensure coordinated, patient-centered care. This role emphasizes patient engagement, care planning, and ongoing follow-up to prevent unnecessary hospitalizations and promote better health outcomes.

Key Responsibilities

• Deliver chronic care management services to patients with complex or high-risk conditions.
• Conduct assessments of medical, educational, and psychosocial needs using standardized tools (e.g., depression, functional, and risk assessments).
• Collaborate with providers, specialists, and families to support development and updates of individualized care plans.
• Help identify and prioritize patients for medical services each day, including prepping any charts to enable efficient and effective provider visits.
• Provide patient and family education, focusing on self-management and capacity for self-care.
• Coordinate care transitions, including timely post-hospital follow-up, medication reconciliation, and education on discharge instructions.
• Document all care management activities accurately and in a timely manner.
• Participate in process improvement activities and quality initiatives.

Skills & Abilities

• Strong clinical knowledge of chronic disease management.
• Excellent communication skills (verbal, written, and listening).
• Ability to engage with patients and families in a supportive, empathetic, and culturally competent manner.
• Strong organizational skills and attention to detail.
• Ability to work independently while collaborating with providers and team members.
• Problem-solving skills with a focus on patient-centered outcomes.

Qualifications

• Must be a Licensed Practical Nurse (LPN) or Certified Medical Assistant (MA).
• Minimum 1–2 years of experience in chronic care management, primary care, ambulatory care, skilled nursing, or hospital settings
• Experience with care management documentation and EHR systems preferred.
• Associate’s degree or higher in a clinical or health-related field preferred.
• Preference given to those with experience in a skilled nursing setting.
• Ability to spend 5 days per week on site with some flexibility to work remotely in the afternoons

Benefits Package

• Health reimbursement account for medical, dental and vision coverage
• 401(k) plan after first year of employment
• Paid Vacation, Paid Sick Time, and 10 Paid Holidays
• Set schedule, no weekends
• Family-friendly work environment

Why Fortis Care

At Fortis Care, we believe every patient deserves attentive, high-quality care delivered where they are. Our physician-led team partners with nursing facilities to provide expert, consistent, and compassionate medical services right at the bedside.

We take a holistic approach to health, combining medical expertise with chronic care coordinators who ensure patients’ needs are met across the continuum of care. From reducing avoidable hospitalizations to empowering patients and families with tools for self-management, our mission is to improve outcomes while treating every patient with dignity and respect.

As part of Fortis Care, you’ll join a collaborative, mission-driven team that values independence, ownership, and doing the right thing for patients and partners. We invest in our people, celebrate hard work, and provide opportunities to grow alongside a company that is redefining post-acute care.