HNE BeHealthy ACO Care Coordinator

Baystate Health; Springfield (MA); Hybrid; USD 35,000 - 47,000; Full time

Job summary

HNE BeHealthy ACO is seeking a Care Coordinator in Springfield, MA to support high-quality, cost-effective care for patients with chronic illnesses and complex social needs. You will act as a liaison among patients, families, providers, payers, and community resources to promote engagement, self-management and continuity of care.

The role involves coordinating referrals, transitions of care, and follow-up while collaborating with the interdisciplinary team.

Qualifications

• 2–5 years of experience in a medical or healthcare setting.
• Experience working with diverse populations and individuals with complex medical and social needs.
• Strong organizational, communication, documentation, and computer skills.
• Ability to work independently and collaboratively as part of an interdisciplinary team.
• Strong patient advocacy and care coordination skills.

Responsibilities

• Serve as a resource, advocate, and point of contact for patients, families, providers, payers, and community resources.
• Coordinate referrals, transitions of care, follow-up, and access to appropriate healthcare and community services.
• Collaborate with the Nurse Care Manager, providers, behavioral health, and other members of the interdisciplinary team to support comprehensive patient care.
• Review care plans with patients and families, monitor progress, and identify barriers to achieving care goals.
• Promote preventive care, self-management, and shared decision-making while helping reduce avoidable ER visits and hospitalizations.
• Maintain accurate and timely documentation in the medical record and track referrals, patient contacts, and follow-up needs.
• Collect and enter data to support program reporting, quality improvement, and evaluation.
• Utilize clinical, research, and quality databases as appropriate.
• Work independently while maintaining strong communication and collaboration with the healthcare team.
• May conduct home visits as needed.

Skills

Organizational skills

Communication skills

Documentation

Computer skills

Care coordination

Education

High School Diploma

Job description

## HNE BeHealthy ACO Care CoordinatorApply: Springfield, Massachusetts: Full time: Posted Today: R44261### The Care Coordinator supports the delivery of high-quality, cost-effective care for patients with chronic illnesses and complex medical and social needs. Working as part of an interdisciplinary team, the Care Coordinator helps patients access appropriate services, navigate the healthcare system, and achieve their care plan goals.The Care Coordinator serves as a liaison between patients, families, providers, payers, and community resources while promoting effective communication, patient engagement, self-management, and continuity of care.### Key Responsibilities* Serve as a resource, advocate, and point of contact for patients, families, providers, payers, and community resources.* Coordinate referrals, transitions of care, follow-up, and access to appropriate healthcare and community services.* Collaborate with the Nurse Care Manager, providers, behavioral health, and other members of the interdisciplinary team to support comprehensive patient care.* Review care plans with patients and families, monitor progress, and identify barriers to achieving care goals.* Promote preventive care, self-management, and shared decision-making while helping reduce avoidable emergency department visits and hospitalizations.* Maintain accurate and timely documentation in the medical record and track referrals, patient contacts, and follow-up needs.* Collect and enter data to support program reporting, quality improvement, and evaluation.* Utilize clinical, research, and quality databases as appropriate.* Work independently while maintaining strong communication and collaboration with the healthcare team.* May conduct home visits as needed.### Required Qualifications* 2–5 years of experience in a medical or healthcare setting.* Experience working with diverse populations and individuals with complex medical and social needs.* Strong organizational, communication, documentation, and computer skills.* Ability to work independently and collaboratively as part of an interdisciplinary team.* Strong patient advocacy and care coordination skills.### Preferred Qualifications* Bilingual skills.* Experience in care coordination, chronic disease management, or working with community resources.**Education:**High School Diploma (Required)**Certifications:**Driver License - OtherOtherOther**Compensation**Note: The compensation range(s) in the table below represent the base salaries for all positions at a given grade across the health system. Typically, a new hire can expect a starting salary somewhere in the lower part of the range. Actual salaries may vary by position and will be determined based on the candidate's relevant experience. No employee will be paid below the minimum of the range. Pay ranges are listed as hourly for non-exempt employees and based on assumed full time commitment for exempt employees.Minimum - Midpoint - Maximum$25.26 - $29.03 - $34.33