Comprehensive Care Coordinator

5 days ago

San Francisco, California, United States The Staff Pad Full time
About The Staff Pad

We are a healthcare organization dedicated to improving the lives of our clients. Our mission is to provide innovative and efficient solutions that drive lasting change.

At The Staff Pad, care management begins with a strong foundation of experience, community networks, high-touch care plans, frequent engagement with extended care teams, and intensive patient involvement. We add advanced monitoring technologies and industry-leading data and analytics to inform care and attain sustainable results.

Care Manager Job Description

The Comprehensive Care Coordinator plays a pivotal role in coordinating and managing comprehensive care for individuals with complex health and social needs. This role requires leading care teams to facilitate care compliance, healthier behaviors, and linkage to providers and community supports to bolster health outcomes and enhance overall wellbeing.

Responsibilities
  • Assessment and Care Planning:
    • Conduct comprehensive assessments of patients' medical, behavioral, and social needs
    • Develop individualized, person-centered care plans addressing specific needs and goals as identified
  • Care Coordination:
    • Act as the primary point of contact for patients, their families, and caregivers, and extended care teams
    • Coordinate across various sectors, including healthcare providers, social services, and community supports ensuring integrated care
    • Facilitate transitions of care from hospital to home or other changes in levels of service
  • Advocacy and Support:
    • Advocate for the patient's needs and preferences in healthcare and social service systems
    • Build trust and rapport with patients empowering them to engage in their care
    • Address barriers to care such as transportation, housing, food insecurity, or safety
  • Monitoring and Follow-up:
    • Regularly monitor patients' progress toward their care plan goals
    • Adjust care plans as needed reflecting changing circumstances or goals
    • Ensure timely follow-up preventing gaps in care or readmission
  • Team Leadership and Communication:
    • Lead and support interdisciplinary teams of consultants, Community Health Coordinators, and extended providers ensuring collaboration and alignment
    • Communicate effectively with all stakeholders maintaining continuity and quality of care
  • Documentation and Compliance:
    • Maintain detailed records of care plans, interventions, and outcomes
    • Ensure compliance with program standards, policies, and regulations
Requirements
  • Strong understanding of medical, behavioral, and social determinants of health
  • Excellent communication, problem-solving, and organizational skills
  • Experience working with diverse populations including those experiencing homelessness, chronic illness, or behavioral health issues
  • Knowledge of local resources and community-based services
  • Customer service orientation and a deep desire to drive outcomes positively impacting patients' lives
  • High-level accuracy and attention to detail
  • Proficiency in communications technology, remote patient monitoring systems, and Microsoft Office
  • Curious, innovative, and open to new approaches to achieving results
Education and Experience
  • PREFERRED: Licensed Mental Health Professional (e.g., LCSW, LMFT, LPCC, LVN)
  • REQUIRED: RN or BSW, Bachelors' degree in psychology, counseling, nursing, or related health field
  • MINIMUM 1 year of experience working with community members in care management or mental health services role
  • Experience supervising staff and managing care coordination tasks
  • Implementing CalAIM or similar healthcare programs preferred
  • Familiarity with utilization management, provider oversight, and billing processes in a healthcare setting

$72,500 - $92,000 salary range based on location and experience.

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