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Care Coordination Specialist
2 months ago
Facilitates the effective management of health conditions, aiming to achieve measurable improvements in patient health outcomes.
Key Responsibilities
Oversees and orchestrates interdisciplinary care for specific populations throughout the care continuum, from wellness to end-of-life considerations, focusing on psychological, social, and environmental factors.
Identifies patients at high risk who require ongoing care coordination; conducts thorough assessments of patients and their families, formulates a comprehensive treatment strategy addressing a range of psychosocial challenges, and implements a care plan that ensures continuous support and coordination for patients and families with complex needs. This includes managing benefits and negotiating care services across various health insurance plans.
Employs innovative approaches to advocate for patient needs and navigates complex systems to eliminate barriers to healthcare access related to psychological, social, and environmental aspects.
Monitors patient transitions across different care environments (e.g., home, clinic, skilled nursing facility, rehabilitation, hospital).
Shares assessment data and psychological, social, and environmental care plans with patient and family consent as patients move through various care settings.
Identifies deficiencies in the care continuum and collaborates with community and provider networks to enhance access to essential psychological, social, and environmental services.
Contributes to the formulation of disease management strategies and determines appropriate metrics for evaluating outcomes.
Participates in the establishment, maintenance, and coordination of an interdisciplinary care delivery framework tailored to individual patient requirements, promoting effective resource utilization.
Collects and analyzes data/outcomes, including but not limited to patient satisfaction, health status, and resource utilization.
Qualifications
Master's Degree in Social Work (MSW) with a minimum of 5 years of clinical experience is required.
Desired attributes include critical thinking skills, strong leadership and communication capabilities, self-motivation, negotiation skills, and conflict resolution proficiency.
Proficiency in computer usage is preferred.
A collaborative team player who employs a systems approach in planning, problem-solving, and decision-making, demonstrating creativity, innovation, risk-taking, autonomy, flexibility, receptiveness to change, and a commitment to professional development is desired.
Licensure/Certifications
None required.
Area of Interest:
Allied Health;
FTE/Hours per pay period:
hrs/per week;
Shift:
Day;
Dartmouth Health is an Affirmative Action and Equal Opportunity Employer.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability.
Dartmouth Hitchcock Medical Center and Dartmouth Hitchcock Clinics comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability, or sex.
