Care Coordinator
Core
Coordinate comprehensive care for patients with kidney disease, focusing on social determinants of health and navigating the healthcare system.
Role type
Senior Care Coordinator (Nephrology)
Builds
Person-centered, holistic care plans and seamless transitions across care settings
Domain
Healthcare / Nephrology / Social Determinants of Health
Required skills
Care coordination, Social Determinants of Health assessment, Resource navigation, Member advocacy, Telephonic outreach, Care plan development, Documentation, Education/Empowerment
Preferred skills
Team-based care approach, Community resource knowledge, Prioritization, Self-direction
Technologies
MS Office Suite (Outlook, Teams), Telephony applications
Responsibilities
Perform telephonic outreach to enroll and engage patients; Develop and implement care plans addressing unique patient needs; Identify social, economic, and environmental factors impacting health; Connect members to resources like housing, transportation, and food security; Guide members in utilizing health and social services; Advocate for members to address barriers to care; Maintain open communication with patients, families, and healthcare teams; Document member interactions and care plans accurately.
Seniority
Mid-level, hands-on IC