The Care Coordination Specialist is an instrumental member of the Care Management team. The Care Coordination Specialist works in collaboration with the RNs & Social Workers embedded in Primary Care who provide care management to patients with complex medical and psycho-social needs Under the direction of the RN Care Manager and/or Social Worker, acts as a resource to assist patients in navigating the health care system and facilitates linkages to community resources that will enable patients to obtain optimal health outcomes.
Dean Clinic offers a one time sign on bonus of $2500.00 to part time and full time Medical Assistant, LPN and Paramedic new hires.
1. Reinforce and facilitate adherence to the plan of care by early identification and resolution of barriers and gaps in care in collaboration with the RN Care Manager and/or Social Worker.
2. Establish positive, supportive relationships with patients.
3. Communicate patient needs and concerns to the care management team when outside of the scope of the Care Coordination Specialist.
4. Assist patients in addressing challenges to care such as transportation, language, family/social support.
5. Help patients in utilizing resources, including scheduling appointments, and assisting with completion of applications for programs for which they may be eligible
6. Coordinate information and referrals for financial and community resources and skillfully links patients and families/significant others to the appropriate resources.
7. Coordinate and completes home and hospital visits and attend office visits as needed.
8. Clearly and effectively communicate both verbally and in writing with the patient's care team and any external providers
9. Documentation all patient interactions in the electronic medical record in a timely and thorough manner
10. Build and maintain relationships with community agencies and services and remains updated on new or changing services.
11. Monitor and manage the Epic Care Management in-basket pool messages and referrals.
12. Maintain confidentiality and complies with professional ethics according to corporate standards.
13. Adhere to department productivity standards.
14. Clerical duties as needed.
15. Perform other duties as required.
1. Licensed Practical Nurse with a minimum two years' experience in ambulatory or home care.
2. Strong written and verbal communication skills with demonstrated customer-focused service skills.
3. Demonstrates ability to work within multidisciplinary teams and dynamic work environments.
4. Demonstrates high level time management, organizational, and priority setting skills.
5. Demonstrated ability to advocate on another's behalf.
6. Demonstrated ability to be flexible and adapt to unforeseen needs or circumstances.
7. Knowledge of local, state, and federal community resources.
8. Effective use of the Internet and Microsoft Office programs such as Word, Excel, PowerPoint and Outlook
9. Ability to travel to various locations, including patient homes.
1. Experience working with medically and socially complex patients.
2. Skilled in crisis, conflict, and stress management.
3. Electronic Medical Record experience (Epic preferred).
About SSM Health Dean Clinic-
Based in Madison, Wis., Dean Clinic consists of a network of more than 60 clinics in south-central Wisconsin. Our more than 500 physicians provide primary, specialty and tertiary care in the clinics as well as eye care through our Davis Duehr Dean locations. Dean Clinic also offers urgent care services and operates outpatient surgery centers. Dean Clinic joined SSM Health in 2013.
You’ve known us as many names throughout St. Louis, and now, we’re bringing our hospitals, doctors, home care and other services together under one name – SSM Health. With seven hospitals, 350+ physicians, more than 40 physician locations and 12,000 employees, we are part of something bigger and better. We’re connected to a wealth of resources, expertise and advance technology to help you, your fa...mily and our community live long, healthy lives.
We’ve grown and changed a lot over our 143-year history. Our name may be changing but our mission remains the same