Integrated Care Coordinator
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Job Location:
Sharon, MA - USA
Hourly Salary:
$ 41 - 76
Posted on:
15 hours ago
Vacancies:
1 Vacancy
Department:
Job Summary
Description
Position at Nuvance Health Med Practice PC
At Nuvance Health we enjoy the benefits of a two-state system as we cultivate an inclusive culture where everyone feels welcomed respected and supported. Together we are a team of 15000 strong hearts and open minds. If you share our values of connected personal agile and imaginative we invite you to discover whats possible for you and your career.
Sharon Hospital is a 78-bed general hospital located in northwestern Connecticut a region that offers an inspiring balance between work and life. We provide a full range of services including bariatric surgery cancer care cardiology emergency care neurosciences orthopedics stroke care surgical services and womens services.
Our accolades include:
- The Leapfrog Group - Grade A for quality and patient safety
- American Heart Association - Stroke Gold Plus Quality Achievement Award
- Vizient Quality Leadership Award
- Center for Medicare and Medicaid Services (CMS) - 5-Star Rating
At Sharon Hospital we pride ourselves on creating a culture of family caring for family. Our message to every patient visitor and caregiver is Were here for you. We are a community of caring hearts providing compassionate care in a warm friendly and supportive environment. The region surrounding our campus is an ideal place to enjoy quality living as you pursue opportunities and make lifelong connections.
Summary:
The Integrated Care Coordinator plays a vital role within the Nuvance Health Primary Care team acting as a bridge between clinical services and community-based wellness resources for older adults. This position is embedded in Primary Care offices where the Coordinator collaborates closely with clinicians nurses and care teams to transform wellness goals into practical accessible services. By addressing social determinants of health (SDOH) through integrated care coordination the role promotes aging in place reduces health disparities and strengthens person-centered care.
Essential Responsibilities:
- Collaborates with primary care clinicians to identify NY-based patients who would benefit from wellness and social support services.
- Conducts in-office or telehealth wellness assessments aligned with clinical recommendations.
- In coordination with the care team create and implement personalized individual and family care plans which are dynamic ongoing and based on the patientï½s needs and goals.
- Connects patients to community-based programs (e.g. transportation nutrition exercise CDSME workshops home support).
- Addresses barriers to participation such as access financial constraints or eligibility.
- Monitors patient engagement and outcomes through follow-up visits and documentation.
- Participates in daily huddles case conferences and care planning meetings with primary care staff.
- Serves as a liaison between Nuvance Health and external partners in the community.
- Supports provider education on referral pathways and community programs.
- Assists with outreach efforts to increase awareness of integrated wellness services.
- Documents all patient interactions in the electronic health record (EHR) and case management system.
- Tracks referral activity review utilization patterns service engagement and patient outcomes.
- Provides regular feedback to the care team and contribute to program evaluation efforts.
- Fulfills all compliance responsibilities related to the position.
- Maintains and models Nuvance Health foundational values.
- Demonstrates regular reliable and predictable attendance.
- Performs other duties as required.
Requirements:
- Bachelors degree in Social Work Public Health Nursing Human Services Gerontology or related field.
- Minimum of three (3) years of experience in case management care coordination or community health.
- Familiarity with aging services health disparities and integrated care models.
- Strong interpersonal and communication skills with the ability to work in a fast-paced clinical setting.
- Proficiency with EHR systems and electronic documentation.
- Valid drivers license and reliable transportation for occasional field visits.
Working Conditions:
Manual: Some manual skills/motor coord & finger dexterity
Occupational: Some occupational risk
Physical Effort: Medium to Heavy effort. May exert up to 35 lbs. force
Physical Environment: Some exposure to dirt odors noise human waste etc.
Salary Range: $41.00 - $76.16 Hourly commensurate with experience
With strong hearts and open minds were pushing past boundaries and challenging the expected all in the name of possibility. We are neighbors caring for neighbors working together as partners in health to improve the lives of the people we serve. If you share our passion for the health of our communities advance your career with Nuvance Health!
Required Experience:
IC
Key Skills
- Senior Care
- Hoyer Lift
- Medical office experience
- Dementia Care
- Home Care
- Nursing
- Alzheimers Care
- Administrative Experience
- Meal Preparation
- Medication Administration
- Memory Care
- Tube Feeding
About Company
Our hospitals, medical practice and care centers are located throughout New York’s Hudson Valley and Western Connecticut. At every location, you’ll find excellent convenient care, a personalized approach, a connected team, and access to our network of doctors. Find care now.
