Care Coordinator-Non Clinical (Psychology)

Nemours is seeking a Care Coordination - Non-Clinical (Psychology), FULL-TIME, to join our team in Jacksonville, Florida.

The care coordinator works within the context of a primary care medical home, from a team approach, and in continuous partnership with families and physicians to promote timely access to needed mental health care, comprehension and continuity of care, and the enhancement of child and family well-being and mental health. Addresses gaps in care and promotes timely access to appropriate care, increasing the utilization of preventative care and healthy behaviors to improve the health of the population at risk.

The position is responsible for the following: 

• Assist with or promote the identification of patients in the practice with special health care needs; add them to the appropriate registry and use the registry to plan and monitor care.  Monitors chronic/preventive patient registries/lists and Gap in Care reports to assist in getting patients the appropriate appointments and/or interventions related to medical and mental health.
• Initiate family contacts: create ongoing processes for families to determine and request the level of care-coordination support they desire for their child/youth or family member at any given point in time.  Identify patient and family needs and unmet needs, strengths and assets.      May facilitate or assist with Family Advisory Committee.
• Build care relationships among family and team; support the primary care-giving role of the family.  Promotes teams and actively participates in daily huddles.  Organizes workshops/training for teams and patients.
• As a member of the care team, monitor patient care plans with family/youth/team (emergency plan, medical summary and action plan as appropriate).  Contacts identified patients for preventative services and/or pre-visit forms.
• Care management coordination of non-clinical services such as, transportation, follow up on referrals, connectivity for appointments etc. Makes follow up communication to patients/families on non-clinical matters such as confirmation of referrals, case coordination, no show appointments, etc.  Follows-up on patient hospitalizations and ER visits as well as identified overdue follow up care needed in coordination with office clinical staff.
• Serve as contact point, advocate and informational resource for family and community partners/payors.      Referrals to child protective services and appropriate agencies. Research, find and link resources, services, and supports with/for the patient/family. Assists with getting insurance coverage for patients without insurance.
• Coordinate inter-organizationally among family, the medical home, and involved agencies.  Identifies community resources and tracks select community and specialty referrals.   Connect to and understand community resources, i.e., WIC, food stamps, DME providers, advocacy groups, schools, financial assistance, counseling, anger management classes, special needs camps or inner-city camps.      Refer patients to early intervention and public health nurses and help office staff and parents navigate through the school system and help with IEPs by making referrals to community agencies.
• Promotes/documents Quality Improvement Cycles.  Responsible for generating required data as appropriate.
• Promotes/documents research outcomes and clinical outcomes for generating required data as appropriate.
• Attend weekly staff and monthly meetings as required.
• Other duties as assigned. 

Job Requirements 

• High School Diploma required. Specialized (1 year of training beyond high school.)
• Minimum three (3) years of experience required.
• Scheduling experience preferred. 
• Bilingual preferred.