No experience
Employment Type:
Full time
Job Category:
Social Service
Care Coordinator
(This job is no longer available)
Care Alliance Health Center | Cleveland, OH
Grad Date

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Job Description


Working with Care Alliance Health Center patients as part of the Patient- Centered Medical Home team, Care Coordinators address and reduce barriers to care. Activities include health care navigation, benefits enrollment and usage, population-specific interventions, community case management, and patient advocacy.


Bachelor's degree in social/human service field preferred, associate's degree and/or commensurate experience considered; Experience and ability to navigate and document in an Electronic Medical Record system; Strong problem-solving skills; Ability to quickly assess and respond to requests for support; Experience working wit h vulnerable populations with chronic illnesses, mental illness, and substance abuse; individuals who are homeless or living in public housing; Ability to work compassionately with a diverse population; Ability to plan, organize and complete associated paperwork in timely manner and maintain confidentiality; Knowledge of relevant community resources and ability to work collaboratively with community service providers; Ability to work independently and as part of a multi-disciplinary team of staff at various skill and professional levels; Ability to establish rapport, develop trust, build collaborative working alliances


Patient Navigation in Primary and Specialty Medical Care:

Support patient comprehension of their diagnosis, treatment plan, and next steps, and connect patients to the appropriate licensed clinical professional as necessary; Support access to specialty care outside Care Alliance such as assisting patients with scheduling appointments; coordinating prior authorizati ons or insurance benefits; basic understanding of procedures; retrieval of specialty care reports, results, or visit summaries back to Care Alliance; and appropriate follow up.


Enrollment a nd Use Screen patients for eligibility, support enrollment, recertification, and follow up as appropriate. Benefits may include Medicaid, Medicare, SSI/SSDI, CHAP, SNAP, WIC, etc.; Provide support and assistance to clients in gathering and completing all necessary documents, submitting to applicable agencies, and appropriate follow up; Educate patients on how to use new insurance options such as basics on managed care network coverage and drug formularies; Support enrollment and use of private benefits such as pharmaceutical assistance programs and Prevent Blindness Ohio.

Population-specific Interventions

Certain populations such as patients with diabetes, individuals with behavioral health needs, or pregnant women, may have special interventions to support engagement in care; Interventions may include collaboration with outside agencies such as Diabetes Partnership, FrontLine Service, or MetroHealth System. Support access to and engagement in interventions as needed.

Comm unity Case Management/Reduction of Barriers

Identify and address non-medical barriers to health and self- sufficiency such as transportation, housing, income, recreation, and education; Based on provider referral and patient screening, connect patients to available community resources such as reduced fare bus tickets, housing support, income a nd food supports, job training, etc.; Link patients to other experts such as Legal Aid or housing case managers, and follow up with patients and external providers accordingly; Establish and maintain positive relationships with community resources and social service agencies to link patients appropriately.


Clearly communicate activities and patient progress with the PCMH team both verbally and through comprehensive and timely documentation in the EMR; Provide relevant information to patients in a fair, accurate, and impartial manner; Safeguard data and documen't s, and maintain strict confidentiality; Participate in necessary trainings; Organize work to meet goals and dead lines, request te am support and guidance as needed


Applicants must be eligible to work in the specified location