Community Care Coordinator

Overview

Connecticut Children’s Center for Care Coordination (The Center) is dedicated to the integration of care coordination through the delivery of innovative programs, providing technical assistance, disseminating best practices, and building inclusive partnerships to strengthen families and build stronger communities. The Center utilizes a universal, evidence based, research informed, and policy driven approach to enhanced care coordination that not only meets the interrelated medical, developmental, behavioral, and social needs of children, but enhances the caregiving capacity of families.

Provide care coordination services to all children (including children and youth with special health care needs and children who are vulnerable and at risk for poor outcomes) by supporting and assisting families with accessing and securing appropriate community services and resources.

• Direct Care Coordination: Provide comprehensive care coordination services to children, youth, and their families by linking them to appropriate medical, developmental, behavioral, educational (etc.), and social services and resources.
• Approach Utilize the strength-based approach, Strengthening Families™, The 5 Protective Factors Framework, to partnering with families.
• Care planning In collaboration with families and in consultation with primary care providers and specialty providers, develop and implement a comprehensive, shared plan of care that addresses specific needs and goals.
• Team collaboration As an integral member of the care coordination team, collaborate with inpatient, outpatient, and behavioral health team members to ensure transitions in care across the continuum that will mitigate gaps, redundancy, and poor health outcomes.
• Advocacy Participate and advocate for families during medical appointments, school meetings, case conferences, etc., as appropriate.
• Meetings Participate in all grant-specific meetings, care coordination collaboratives, and various community meetings as appropriate. Meet required grant deliverables as indicated.

• Center activities Participate fully in Center activities: staff meetings, work groups, innovative programs and projects, research activities.

• Communication Communicate with providers via fax/email on progress of services.
• Record keeping Document all care coordination activities in databases as appropriate.
• Confidentiality Adherence to current HIPAA guidelines in ensuring patient/family confidentiality.

• Family empowerment Empower families to direct the care of their children within the medical home model by formulating a care plan that promotes self-advocacy, networking skills, and culturally relevant services.
• Education and referrals Provide education, consultation, referrals, training and support to families and community providers through direct advocacy, technical training, and educational materials.
• Policy and collaboration Collaborate with colleagues in the Center for Care Coordination by providing information and technical assistance on cases, attending care management meetings, and assisting in the development of center policies and procedures.
• Issue resolution Address issues that negatively impact cost and quality of care, liaise with Connecticut Children’s Medical Center on-site and satellite programs serving children with special health care needs.

Demonstrates knowledge of population-specific differences and needs from neonate through adolescence and applies them to practice. Demonstrates cultural sensitivity in all interactions with patients/families and co-workers. Supports the mission, values and goals of the organization.

• Education Bachelor’s degree in social work, Family and Human Development, Public Health, or related fields.
• Experience Minimum of 3 years’ experience working with families and community systems; may substitute for degree.

• License Valid CT Driver’s License; willingness to drive own vehicle throughout North Central Region and State of CT

Knowledge

• Community resources/social…