Patient Coordinator Home Health

Monday through Friday 8a to 5p shift

Essential Functions

• Engages a population of medically vulnerable or chronically ill patients in their care, assisting them through the process of working towards better health by providing support, encouragement and education.
• Communicates and maintains relationships with other members of the Care Management team to promote a lifelong, proactive partnership with patients to enhance and personalize management of health-related needs.
• Completes screenings on patients for social determinants of health needs and refers as appropriate.
• Communicates with patients and caregivers in person, by telephone and via electronic means.
• Utilizes Chronic Disease Management protocols, under the direction of clinical teammates; monitors patient-reported biometrics, medication adherence, reported challenges/barriers and promptly connects the patient with the appropriate resources, and/or notifies the patient's care team for additional follow-up.
• Provides customized, evidence-based patient education in a variety of areas, under the guidance of clinical teammates and based on the patient's readiness to change; includes but not limited to weight management/exercise, tobacco cessation, stress reduction and chronic disease self-management. Uses Motivational Interviewing skills to engage and assist patient/parent/family.
• Assists providers' offices/ medical home staff with member specific missed appointments through outreach and scheduling.
• Advocates and facilitates referrals to gain access to services and resources for patients, including patient assistance programs, community-based services and mental health support.
• Assists with the coordination of care across the care continuum and transitions of care (including home care, outpatient care, ER care, and hospital care) while maintaining strict patient confidentiality.
• Advocates to help those who frequently access inappropriate levels of care.

Work requires walking, standing, sitting, lifting, reaching, bending and stooping. Must lift a minimum of thirty-five pounds shoulder high. Ability to travel/ drive between various locations is required for this position. Requires frequent verbal and written communication in English. Must have intact sense of sight, hearing and finger dexterity. Occasional intermittent noise and exposure to conditions such as dust, fumes and chemicals.

A High School Diploma or GED is required. Must possess excellent verbal and written communication skills. Must possess basic computer knowledge and ability to use Microsoft office applications. Strong organizational skills. Must have effective interpersonal skills. Must be able to respond quickly to changes in community and clinic settings.

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:

Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.