Lead Care Coordinator

HealthWorks for Northern Virginia is a non-profit Federally Qualified Health Center (FQHC) serving the medically underserved and uninsured populations of Northern Virginia. We provide quality medical, dental, and behavioral health care to all ages who might not otherwise be able to afford it. For more information about who we are and what we do, please visit www.hwnova.org.

Work Life Balance ? NO WEEKENDS!! Competitive Salary and Benefits package includes a 401K Retirement Plan, Medical, Dental, Vision, Group Life, STD, LTD; Paid Time Off and 10 Paid Holidays.

HealthWorks is a mandatory COVID-19 and flu vaccine organization.

Pay starting at $25/h

Definition

He/she works closely with patients, providers and others to provide coordinated, patient-centered care. Responsible for coordinating care for the complex needs of patients with chronic conditions within the HealthWorks for Northern Virginia setting. This will include providing coordination of care, referring to appropriate clinical support, patient education, and continuous care.

Roles & Responsibilities

• Adhere to all HealthWorks of Northern Virginia policies and procedures.
• Assists all patients through the healthcare system by acting as a patient advocate and navigator.
• Creating an evidence-based care plan for providers and an action plan for patients and caregivers.
• Identify the patient?s and family?s physical, psychosocial, environmental, safety and developmental needs and individualizing the patient?s plan of care based on the needs identified.
• Promoting patient self-management and disease and behavior modification interventions.
• Promotes clear communication amongst a care team and treating clinicians by ensuring awareness regarding patient care plans.
• Coordinating the efforts of all care providers (hospitals, specialists, rehab facilities, home care, hospice, and social service agencies).
• Educating and supporting family caregivers.
• Facilitating access to community resources.
• Document problems, patient assessments, appropriate goals, care provided, care interventions and patient and family outcomes achieved from intervention and care provided.
• Teach and/or coordinate with the patients? healthcare team the appropriate interventions, caregiver, volunteers and others as appropriate.
• Participates on a team for data collection, health outcomes reporting, clinical audits, and evaluation related to Patient-Centered Medical Home.
• Performs various duties to ensure quality patient care, excellent patient flow, and efficiency of operations within the HealthWorks for Northern Virginia.
• Participates in Center projects, initiatives, and/or committees as requested.
• Completes appropriate paperwork in a timely and legible manner.
• Keeps professional certifications active, current status and renews timely.
• Responsible to update and maintain of electronic medical records through EMR system, assuring accuracy, completeness and compliance with regulations, certification standards, legal and ethical standards.