Referrals - Patient Care Coordinator

Unicare Community Health Center; Ontario (CA); Hybrid; USD 42,000 - 64,000; Full time

Job summary

The Unicare Community Health Center seeks a Patient Care Coordinator to support chronically ill and high‑risk patients in a team‑based approach with families, providers, and community resources.

Responsibilities include creating care plans, increasing preventive care, reducing ER visits, ensuring timely access, and guiding patients through referrals and transitions with strong communication and advocacy.

Qualifications

• High school diploma; medical assistant certification preferred.
• Strong communication, interpersonal, and patient-service skills.
• Ability to manage competing priorities with good judgment.

Responsibilities

• Create and promote care plans with patients, families, and providers.
• Increase preventive care utilization and reduce ER visits.
• Promote timely access to care and continuity through referrals.
• Coordinate with tertiary providers, transitions, and referrals.
• Support patient self-management and shared decision-making.
• Connect patients to community resources and advocate as needed.
• Provide one-on-one guidance and problem-solving within the health system.
• Be the system navigator and point of contact for patients and families.
• Identify community resources and maintain relationships with providers.
• Assist with referral information and patient education.
• Adhere to privacy, professionalism, and organizational policies.

Skills

Strong customer service

Effective communication

Teamwork

Organized / multitask

Good judgment

Problem solving

Accountability

Education

High School Diploma / MA cert

Job description

Job Summary

Patient Care Coordinator works in collaboration and continuous partnership with chronically ill or “high-risk” patients and their family/caregivers, clinic providers and staff, and community resources in a team approach.

Essential Functions

1. Create and promote adherence to a care plan, developed in coordination with the patient, primary care provider, and family/caregivers.
2. Increase utilization of preventive care.
3. Reduce emergency room utilization and hospital admissions.
4. Promote timely access to appropriate care.
5. Increase continuity of care by managing relationships with tertiary care providers, transitions-in-care, and referrals.
6. Increase patient’s ability for self-management and shared decision‑making.
7. Connect patients to relevant community resources, with the goal of enhancing patient health and well‑being, increasing patient satisfaction, and reducing health care costs.
8. Working closely with patients on a one-on‑one basis.
   1. Provide guidance, support, and advice to patients dealing with complex medical issues
9. Assemble information concerning patient's clinical background and referral needs. Per referral guidelines, provide appropriate clinical information to specialist.
10. Review details and expectations about the referral with patients.
11. Assist patients in problem solving potential issues related to the health care system, financial or social barriers (e.g., request interpreters as appropriate, transportation services or prescription assistance).
12. Be the system navigator and point of contact for patients and families, with patients and families having direct access for asking questions and raising concerns. May assume advocate role on the patient's behalf with the carrier to ensure approval of the necessary supplies/services for the patient in a timely fashion.
13. Identify and utilize cultural and community resources. Establish and maintain relationships with identified service providers.

Non-Essential Functions

• As directed by the Referral Department Supervisor, performs other related and/or necessary tasks to achieve organizational and programmatic goals and objectives.

Professional Requirements

• Adhere to dress code, appearance is neat and clean.
• Maintain patient confidentiality at all times.
• Report to work on time and as scheduled.
• Maintain regulatory requirements, including all state, federal and local regulations.
• Represent the organization in a positive and professional manner at all times.
• Comply with all organizational policies and standards regarding ethical business practices.
• Communicate the mission, ethics and goals of the organization.
• Participate in performance improvement and continuous quality improvement activities.

Qualifications and Experience

• Strong customer service focus
• Effective verbal and written communication skills
• Teamwork orientation
• Organized and able to manage competing priorities
• Good judgment
• Resourcefulness in problem solving
• Able to take and follow through with delegated tasks and accountability

Training, Education and Licensure:

• High School Diploma, sometimes combined with Medical Assistant Certification.

Physical Requirements and Environmental Conditions

• Pushing and pulling objects up to 25 lbs.
• Frequent wrist, hand and finger dexterity to perform fine motor function.
• Full range of body motion including twisting body, pushing, pulling
• Position requires light to moderate work with 25 lb. maximum weight to lift and carry.
• Position requires reaching, sitting down for long periods of time, walking, bending, stooping, and handling objects with hands and/or fingers, talking and/or hearing, and seeing.

Work Schedule

• 40 hours per week. Monday – Friday; 9am – 6pm, part or all of an 8-hour shift. Occasional Saturday shift may be

required.

Working Conditions

• Non-Ionizing Radiation (microwaves, sun)
• Hazardous Exposure (chemical [E.G. Latex])