Care Management Coordinator — Patient-Centered Outreach

Northwell Health; Melville (NY); On-site; USD 65,000 - 90,000; Full time

Job summary

Northwell Health is seeking a Care Management Coordinator to support families and caregivers in Duchess, Putnam, and Ulster counties. You will use patient-centered motivational interviewing to engage patients and assist the primary care team with panel management.

The role emphasizes developing and maintaining individualized care plans for high-risk patients, addressing medical and social barriers, and coordinating between hospitals, primary care, specialists, and community resources to improve

Qualifications

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

Responsibilities

• Uses patient-centered motivational interviewing techniques to build rapport and help patients improve their health.
• Supports the care team by panel management to reduce loss to care and non-compliant follow-ups; develops and adjusts care plans for high-risk patients addressing medical and social barriers.
• Acts as a liaison between hospitals, primary care providers, specialists, and community resources to ensure patient-centered care coordination.
• Identifies and tracks high-risk populations and preventive or chronic care needs.
• Identifies and tracks patients discharged from inpatient or ED settings.
• Uses team-based communication to close referrals and follow-ups; conducts outreach in primary care sites, homes, hospitals, and neighborhoods.

Skills

Bilingual Spanish

Driver's license

Education

High School Diploma or equivalent

Bachelor's or Master's degree preferred

Job description

Northwell Health is seeking a Care Management Coordinator to support families and caregivers in Duchess, Putnam, and Ulster counties. You will use patient-centered motivational interviewing to engage patients and assist the primary care team with panel management.

The role emphasizes developing and maintaining individualized care plans for high-risk patients, addressing medical and social barriers, and coordinating between hospitals, primary care, specialists, and community resources to improve