Patient-Centered Care Coordination Specialist

Northwell Health; Melville (NY); On-site; USD 70,000 - 90,000; Full time

Job summary

Northwell Health in Melville, NY is seeking a Care Management professional to coordinate patient-centered care, working with families and caregivers to improve health outcomes. You will use motivational interviewing, manage care plans for high-risk patients, collaborate with hospitals, PCPs, specialists and community resources, and help reduce gaps in follow-up and access.

Required is a high school diploma with 1-3 years of relevant experience; bachelor's or master's degree preferred; bilingual

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

• Utilizes 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, non-compliant in follow up care or disconnected from primary care. Participates in the development, maintenance, and adjustment of individualized care plans for high-risk patients that address both medical and social barriers to accessing care.
• 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, hospital follow-ups and any outstanding items identified in the patient's care plan. Performs outreach activities in primary care sites, homes, hospitals, and neighborhoods.

Skills

Motivational interviewing

Care coordination

Team-based communication

Rapport building

Education

High School Diploma or equivalent

1-3 years experience

Bachelor's degree preferred

Master's degree preferred

Health home or care management experience preferred

NYS Driver's license preferred

Bilingual Spanish preferred

Job description

Northwell Health in Melville, NY is seeking a Care Management professional to coordinate patient-centered care, working with families and caregivers to improve health outcomes. You will use motivational interviewing, manage care plans for high-risk patients, collaborate with hospitals, PCPs, specialists and community resources, and help reduce gaps in follow-up and access.

Required is a high school diploma with 1-3 years of relevant experience; bachelor's or master's degree preferred; bilingual