Promotes the mission and vision of North Country HealthCare (NCHC) as a key integrated care team member who supports clients under the direction of their primary care provider and in collaboration with other care team members (ie. RN Care Managers, Pharmacy, BH) through implementation and ongoing monitoring of an appropriate and effective patient-centered care plan through education/coaching on self-management plans and health promotion, advocacy, coordination of care and services, and linkage to additional community-based support.

What you will be doing in this role:

• Care Coordination: Responsible for organizing, coordinating, and linking services for empaneled patients.
• Care Plan Development: Utilize motivational interviewing and other techniques to develop a patient centered care plan.
• Education/Coaching: Connect patients with educational materials and additional resources.
• Navigation: Assist patient by linking them to information/services to aid in health-related decisions.
• Care Transitions: Facilitate and identify patients transitioning from hospital care to the primary care provider effectively.
• Community Resources: Collaborate with community partners, specialty care providers, etc to provide optimal care.
• Integrated Care Team: Actively participate with the clinical care team to support, engage, and follow-up with the patient with provider-guided treatment goals.
• Communication: Document all encounters in the patient chart within the Electronic Health Record.

What qualifies you for this role:

• 4-Year College degree or equivalent experience in related field, with 2 years experience
• Coachability/Willingness to learn and be trained
• BLS (can complete upon hire)
• Intermediate level: Spreadsheet, Word Processing/Typing
• Basic: Presentation/Powerpoint
• Basic: Electronic Health Record (Training can occur, if not familiar)

Benefits:

• Health Insurance starts on day one, as little as $5 per pay check
• Dental, Vision, 401K Matching, Employee Assistance Program
• 22 Combined days of PTO/PST, 6 paid Federal Holidays and 2 Floating Holidays in first year, Accrual starts on Day 1
• No nights or Weekends
• Loan Repayment and Tuition Reimbursement Programs
• Career growth and Professional Development

North Country HealthCare follows CDC guidelines and federal mandates and requires vaccination against COVID-19 of all its employees. Medical and religious exemptions to this policy are requested and reviewed on an individual basis.