Population Care Coordinator

This is not a remote position

Support and participates in the Patient-centered Medical Home (PCMH) concepts of care coordination and team- based care. Assess, plan, implement, coordinate, monitor and evaluate healthcare options and services with the goal of increasing the likelihood of improvement to the health status of identified populations across the continuum. • Follow established PCC workflow for utilization and self-management support • Participate in PCMH activities which include but are not limited to: hospital discharge follow-up, care planning, coordination of services, and communication between care providers • Collaborate with patient’s medical/health and community-based providers to establish mutual goal-setting including patients and their families/caregivers, utilizing self-management tools. • Provide outreach, care management and education for disease self-management per patient centered goals.

Additional responsibilities to the Current Population Care Coordinator Position Provide care coordination and management for all patients enrolled in Cooper’s Remote patient monitoring program within their scope and standards of practice

Triages patients with change in clinical status and follows escalation of care pathway

Utilizes disease specific clinical protocols to enhance patient care and outcomes

Experience Required

3-5 Years experience

Education Requirements

BSN

RN License