Care Coordinator

Who We Are

Aviva Health is a dynamic and mission-driven federally qualified health center (FQHC). Committed to providing comprehensive and compassionate healthcare services, Aviva Health offers a holistic approach to care, addressing patients' medical, behavioral health, dental, and social service needs. As a vital healthcare resource in the community, Aviva Health fosters a collaborative and supportive work environment where dedicated healthcare professionals have the opportunity to make a meaningful impact on the lives of individuals and families. Join us at Aviva Health and be part of a team that is dedicated to making a difference in the lives of our patients and the community we serve.

Benfits included

Monday - Friday Scheduling Paid Holidays PTO Comprehensive Medical, Dental, and Vision Coverage 403B Contribution

Position purpose

• Under the general supervision of the RN Case Manager, the Care Coordinator performs certain case management and clinical duties. Case management duties may include transitions of care, chronic care management, Coumadin management, Alternative Payment Care Model-related (APCM-related) activities, and other case management duties. The Care Coordinator promotes and evaluates the effective utilization of resources using current knowledge and awareness of community resources and assumes a pivotal role with the patient care team to achieve optimal clinical and resource outcomes. Clinical duties may include taking and recording vital signs, drawing certain labs, and direct care duties as needed and in accordance with established policies and procedures. Administrative duties may include generalized care coordination, scheduling medical visits as indicated, and working with care teams to perform comprehensive chart reconciliation and review.
• Essential
• FUNCTIONS: Serve as a Care coordinator for identified patient population needing care management services. Assist RN Case Managers as needed for Aviva Health’s case management services. Draw labs per clinic policies and procedures if skills check completed. Assist various departments regarding APCM Care Services That Engage Patients (STEP) and other as-needed functions and duties that relate to the APCM. Utilize communication, organizational, and problem-solving skills to implement the care coordination interventions defined by the Primary Care Provider, RN Case Manager, or specialty providers information available to them from the patient’s electronic medical record (EMR). Promotes and evaluates the effective utilization of resources using current knowledge and awareness of community resources and assumes a pivotal role with the patient care team to achieve optimal clinical and resource outcomes. Assist physicians and nurses as needed in coordination of care services. Help patient actively and knowledgably participate with their primary care and case management team in healthcare decision making. Assist case management team with high level of productivity and accuracy to improve performance metrics and patient outcomes. Assist with care coordination between patient and case management team. Assist with compliance with HRSA continuity of care regulations.