Care Coordinator & Population Health Advocate (In-Office)

Alabama Primary Health Care Association; Montgomery (AL); On-site; USD 90,000 - 110,000; Full time

Job summary

Alabama Primary Health Care Association (APHCA) seeks a Care Coordinator to support comprehensive care coordination activities across Alabama. The role partners with FQHCs, RHCs, and community providers to identify gaps, engage patients, and ensure timely follow-up of referrals.

The ideal candidate is organized, proactive, and outcomes-focused with experience in care coordination and patient engagement, able to serve diverse populations while maintaining confidentiality and professionalism.

Qualifications

• ADN or Practical Nursing Certificate from an accredited institution.
• Current, unrestricted Alabama or compact state nursing license.
• Minimum of five (5) years of clinical healthcare experience.
• Experience in patient care coordination, case management, or care management activities.
• Experience collaborating with diverse stakeholders across healthcare organizations and community partners.

Responsibilities

• Identify care gaps and monitor open referrals using care coordination platforms.
• Engage patients and families to assess needs and facilitate access to care and resources.
• Develop individualized patient goals and action plans and monitor progress.
• Coordinate appointments and referrals with primary care providers, specialists, and behavioral health providers.
• Provide education and guidance to patients and families for informed health decisions.
• Collaborate with multidisciplinary teams to ensure coordinated, patient-centered care.

Skills

Organizational skills

Planning

Communication skills

Team collaboration

Multitasking

Education

Associate Degree in Nursing (ADN)

Practical Nursing Certificate

Bachelor of Science in Nursing (BSN)

Tools

MS Office

EHR systems

Job description

Alabama Primary Health Care Association (APHCA) seeks a Care Coordinator to support comprehensive care coordination activities across Alabama. The role partners with FQHCs, RHCs, and community providers to identify gaps, engage patients, and ensure timely follow-up of referrals.

The ideal candidate is organized, proactive, and outcomes-focused with experience in care coordination and patient engagement, able to serve diverse populations while maintaining confidentiality and professionalism.