Care Coordinator

Job Description Summary ‎ The Care Coordinator works under the direction of the RN Care Manager and in collaboration with primary care providers, patients, caregivers, and interdisciplinary team members to support care management activities in the outpatient setting. This role assists with care coordination, transitions of care, chronic disease management, patient outreach, resource navigation, and documentation to improve patient outcomes, reduce avoidable utilization, and enhance the patient experience. The Care Coordinator may be a Licensed Practical Nurse (LPN) or an experienced Medical Assistant (MA) with strong clinical knowledge and care coordination experience. ‎ How will you make an impact & Requirements ‎ Program Goals The Care Coordinator supports the following organizational goals: Prevent unnecessary emergency department visits and hospital admissions. Reduce 30-day hospital readmissions. Improve communication and care coordination between Primary Care Providers (PCPs), specialists, and acute care settings. Facilitate safe and effective transitions of care. Support advance care planning discussions and documentation. Assist patients and caregivers in identifying the most appropriate level of care following discharge. Improve patient engagement, self-management, and adherence to care plans. Essential Responsibilities Care Coordination Assist the RN Care Manager in implementing and monitoring individualized patient care plans. Perform monthly patient chart reviews to identify care gaps, preventive care needs, and opportunities for intervention. Monitor and track follow-up appointments, referrals, diagnostic testing, and care plan goals. Coordinate services among primary care providers, specialists, hospitals, skilled nursing facilities, home health agencies, and community organizations. Collaborate with the healthcare team to ensure continuity of care across settings. Patient Outreach and Engagement Conduct telephonic outreach to patients and caregivers as directed by the RN Care Manager. Assess barriers to care, including transportation, medication access, financial concerns, health literacy, and social determinants of health. ‎ Compensation Range: $19.00 to $28.50 The anticipated base salary range represents the Company's good-faith estimate of the compensation it reasonably expects to pay for this position at the time of posting. Actual compensation will be determined based on factors including experience, skills, qualifications, geographic location, internal equity, and business needs. Beware of fraudulent job postings: While Mosaic Health job advertisements may be found on many sites, our current openings page and its associated Workday account are the only places we accept applications for open roles. If you suspect a job post is fraudulent, please let us know at recruiting@apree.health. Mosaic Health is a national care delivery platform focused on expanding access to comprehensive primary care for consumers with coverage across Commercial, Individual Exchange, Medicare, and Medicaid health plans. Learn More about Mosaic Health Learn More about Millennium Physician Group Learn More about CareMore Health Learn More about Castlight Health Learn More about Vera Whole Health