Perinatal Care Coordination Specialist

TEAMS Constructions; Washington (District of Columbia); On-site; USD 35,762 - 37,084; Full time

Benefits offered by this job

Top Workplace recognition

Paid lunch and 8-hour workdays

Vacation + holidays

Job summary

Community of Hope in Washington, DC is seeking a Perinatal Care Coordination Specialist to assess patient risks, provide health education, create individualized care plans, and connect patients with social services and community resources that address barriers to positive maternal and infant health outcomes.

This role serves as the primary liaison between patients and the healthcare system, supporting patient activation, monitoring progress toward health goals, and coordinating care to ensure

Qualifications

• BA/BS in social work or education or equivalent experience.
• Valid BLS Certification.
• Experience providing social services, care coordination or health care education.
• Ability to travel between COH locations.
• Vaccination against COVID-19 is required; accommodations possible.

Responsibilities

• Maintains a caseload of 40-60 perinatal participants with social/medical risk factors.
• Develop individualized care plans with short- and long-term goals.
• Orient participants to COH and external programs to increase adherence to care.
• Coordinate referrals and warm handoffs to needed supports.
• Provide health education to support perinatal goals and child development milestones.
• Ensure infants receive ASQ screenings prior to discharge and support parenting education.
• Meet monthly follow-up goals and document progress.

Skills

Strong communication

Multitasking

Problem solving

Travel between COH locations

Education

B.A./B.S. in social work or education or equivalent experience

Tools

BLS Certification

Job description

Washington, DC | On-Site | $25.96 - $26.92 per hour | Washington Post Top Workplace (8x Winner)

Community of Hope is seeking a Perinatal Care Coordination Specialist to assess patient risks, provide health education, create individualized care plans, and connect patients with social services and community resources that address barriers to positive maternal and infant health outcomes. This role serves as the primary liaison between patients and the healthcare system, supporting patient activation, monitoring progress toward health goals, and coordinating care to ensure timely access to clinical and social supports. This position is located at our Family Health and Birth Center in NE, Washington, DC.

Our Approach and Values

• We celebrate people’s strengths and acknowledge the impact of trauma on people’s lives.
• We embrace diversity, welcome all voices, and treat everyone with respect and compassion.
• We lead and advocate for changes to make systems more equitable.
• We strive for excellence and value integrity in all that we do.

What You’ll Do

• Maintains a caseload of 40-60 perinatal participants with social and/or medical risk factors that place them in Tier 2 or 3 of the Maternal and Child Health risk stratification.
• Collaborates with each participant on caseload to develop an individualized care plan containing short- and long-term goals with particular emphasis on addressing risk factors (including but not limited to social needs, barriers to care, pregnancy planning, and food insecurity) and supporting positive child development.
• Orients all caseload participants to COH and external support programs and services that can increase adherence to needed care (e.g., transportation, First Shift Justice Project, perinatal care coordination, language access, Nurse Advice or Midwife on Call Lines). Collaborates with patients to identify the most beneficial programs to make referral.
• Orients all caseload participants on external support programs and services that can improve maternal and child health outcomes (e.g., doulas, Home Visiting, dental care, Emotional Wellness, WIC, lactation education and consultations, car seats, cribettes, parenting groups, Family Success Center, sexual health care coordinators, etc) and support them in reaching their identified goals. Collaborates with patients to identify the most beneficial programs to make referral.
• Orients all caseload participants of COH intrapartum support--provides education on birthing options and locations, doula supports, warning signs, and Midwife on Call line.
• Ensures that participants utilize referrals to support programs and services by implementing closed loop referral process which includes warm handoffs, completion of Release of Information to share patient information with resources or supports, three-way calls, and reminders.
• Provides health education to support goals and perinatal stage in a variety of settings with an emphasis on increasing understanding of health behaviors to support healthy pregnancies, self-management of care, infant care, and child development milestones.
• Ensures that 100% of infants of caseload participants receive at least 2 Ages and Stages Questionnaire screenings prior to discharge and provides child development education and activities to increase achievement of milestones.
• Adheres to monthly follow up goals for patients based on tier. Attempts to complete in person or telephonic monthly follow up on 100% of patients on caseload. Follow up includes an assessment of current social needs, documentation of materials and resources provided, and status update on individualized care plans.
• Promotes breastfeeding during interactions with patients. Provides breastfeeding support to include assessing latching and feeding process, providing corrective interventions, counseling lactating persons, increasing understanding and applying knowledge of milk production and other commonly encountered situations.
• Completes other duties as assigned by supervisor.

Requirements

Must-Haves

• B.A./B.S. in social work or education or equivalent experience.
• Valid BLS Certification.
• Experience providing social services, care coordination or health care education.
• Ability to multi-task and problem solve.
• Strong written and verbal communication skills.
• Ability to travel between other COH locations and travel between COH sites.
• Proof of vaccination against?COVID-19 is required. COH will consider requests for reasonable accommodations for anyone who cannot be vaccinated for a religious or medical reason, subject to applicable law.

Nice-to-Haves

• Experience in community health center setting.
• Familiarity with Medical Assistance system and community resources strongly.

Why You’ll Love Working Here!

• 8 x Washington Post 150 Top Workplaces winner.
• 8-hour workdays with paid lunch.
• 3 weeks vacation (additional week after two years), 2 weeks sick leave, + 11.5 paid holidays and one personal floating holiday on an annual basis.
• Annual performance-based raises, up to 5% of your annual pay.
• Tuition reimbursement & loan repayment (NHSC & DCHPLRP), Licensing reimbursement & CEU funding.
• Medical, dental, vision, life & disability insurance + 403(b) retirement.
• Leadership development, internal promotions and career growth opportunities.
• A culture grounded in equity, compassion, and well-being.

About Us

Community of Hope is a mission-driven, innovative, rapidly growing nonprofit, and Federally Qualified Health Center. For over 45 years, we have provided health and housing services, perinatal care coordination, and community support services to make Washington, DC more equitable. Community of Hope also strongly emphasizes maternal and child health, with midwifery practice and the only free-standing birth center in DC. We are honored to be one of DC’s largest providers of housing and homelessness prevention services for families and individuals throughout DC. Through our Family Success Center, our WIC nutrition centers, and our various partnerships, we have reached hundreds and believe that everyone in DC deserves to be healthy, housed, and hopeful. With the help of our amazing staff, we have successfully provided:

• 50,000+ medical visits
• 6,300+ dental visits
• 17,000+ emotional wellness visits
• 1,384 families and 220 individuals with housing/homelessness prevention services

Community of Hope is an equal opportunity employer.