Care Coordinator, Health Home

A Health Home is a network of caregivers who work in collaboration with one another to ensure that Health Home consumers, (chronically ill individuals) receive comprehensive care coordination. The ultimate goal of Health Home is to ensure consumers stay healthy, out of the emergency room, and out of the hospital.

As part of the Care Manager Team, the Care Coordinator is responsible for managing all aspects of care for Health Home consumers. This includes tracking and arranging appointments, working in partnership with treatment providers, offering consumer advocacy and education, and coordinating other aspects of the consumer's community services. As this is an evolving program, additional responsibilities will be added.

Duties include, but are not limited to:

  • Coordinate all services for a designated caseload

  • Develop an Individualized Care Plan (ICP) collaboratively with the consumer, their family and/or caregivers, and other service providers

  • Ensure consumers have access to and participate in needed services as defined in their ICP

  • Complete all necessary documentation in a timely manner to facilitate Medicaid billing and maintain all consumer charting using an electronic software program

  • Respond to consumer's requests for information and referral

  • Other duties as assigned


Bachelor's degree in Social Work, Psychology or a related health/human services field, one year of direct work with the target population.

Preferred Skills:

Excellent oral and written communications skills; bi-lingual, Spanish speaking a plus; proficiency in Microsoft Office Suite; and experience charting in an electronic health record such as Foothold's AWARDs.

To apply: e-mail resume and cover letter indicating position and salary requirements to: EOE.