If you are looking to be part of a non-profit agency that has an excellent reputation, strength-based supervision and high regard when it comes to honoring the mission of our work, Bay State Community Services is the right place for you. Apply now!!
The Care Coordinator works in collaboration and continuous partnership with chronically ill or “high risk” enrollees and their family/caregiver(s), clinic/hospital/specialty providers and staff, and community resources in a team approach.
What You Will Be Doing to Make a Difference…
- Develop a care plan with the patient, family/caregiver(s) and providers (emergency plan, health management plan, medical summary, and ongoing action plan, as appropriate) within 90 days of Enrollee’s Assignment. Update the plan at least every 6 months
- Facilitate and attend meetings between patient, family/caregiver(s), care team, payers, and community resources as needed
- Cultivate and support primary care and specialty provider co-management with timely communication, inquiry, follow-up and integration of information into the care plan regarding transitions-in-care and referrals
- Assist with the identification of “high-risk” enrollees (the chronically ill and those with special health care needs), and flag in the EMR
Schedule: Monday – Friday (9a-5p, 8a-4p or 8:30a-4:30p)