The Fortify Cares Care Coordinator utilizes their skills and knowledge base to support the optimal health and wellness of the pediatric patient. Through telephonic outreach, the care coordinator will communicate with patients’ families to complete assessments and develop individualized care plans that best support the medical and social needs of the patient and family. Highly developed written and verbal communication skills that facilitate patient/family understanding of health needs is essential. The Fortify Care Coordinator provides education, support, referrals, advocacy, and ongoing care coordination to support patient and family wellness. This position requires strong organizational skills in order to multi-task and prioritize referrals, assignments, and requests. The successful candidate has a demonstrated track record of building respectful rapport and trust with patients, families, providers and community partners; completing assessments of physical and psychosocial needs; identifying appropriate healthcare and community resources; collaborating with team members. This position requires confidentiality, discretion, and collaboration.

Provides care that is inclusive and respectful of socioeconomic status, race, ethnicity, age, mental or physical disability, religion, gender, sexual orientation, or national origin

Builds open, trusting, respectful relationships with diverse patients and families both remotely and in person

Engages critical thinking skills to support the development and execution of Individualized Plans of Care

Anticipates and responds to patient and family needs

Communicates effectively with diverse audiences both orally and in writing

Works with interdisciplinary teams to improve patient, family, and community outcomes

Electronically documents care according to industry and institutional standards, including HIPAA-compliant documentation

The job includes the following essential functions:

Assisting with biopsychosocial assessments and identification of medical and social needs for patients and families.

Reading and implementing an Individualized Plan of Care and evaluating progress towards identified goals.

Engaging in ongoing communication to interdisciplinary care team members and other partners to provide progress on care needs, referrals, barriers, and outcomes 

Identifying relevant community resources to benefit patients and families

Completing and following-up on referrals to community resources to optimize effective and efficient care outcomes in collaboration with other members of the multidisciplinary team

Building relationships with schools and other community partners to facilitate seamless referral and care coordination

Engaging in continued professional education regarding Care Management best practices

Consistent documentation that meets care, regulatory and accreditation requirements

In addition to the above job responsibilities, other duties may be assigned.

MINIMUM REQUIREMENTS

Education: Bachelor's degree in a Health or Human Services field.

Experience: 2+ years of relevant professional experience, preferably in care coordination or social work. Strong understanding of care coordination best practices. Experience working with children, families, community partners. Strong organizational skills and the ability to work independently. Excellent communication skills and the ability to interact with diverse individuals; Bilingual a plus. Prior experience working with Medicaid populations. Experience conducting medication reconciliation with patients and identifying discrepancies. Comfort working in a fast pace and dynamic “startup” environment.

Licensure: None

Physical Demands:
Normal office environment with little exposure to excessive noise, dust, temperature and the like..

Position Compensation Range: $43,894.00 - $87,788.00 Annual

Benefits

Comprehensive Benefits Package: Medical, Dental, and Vision Insurance

Paid Time Off, Long-term and Short-term Disability, Retirement Savings

Health Saving Plans, and Flexible Spending Accounts

Certification and education support

Generous Paid Time Off

UVA Health is a world-class Magnet Recognized academic medical center and health system with a level 1 trauma center. 2023-2024 U.S. News & World Report “Best Hospitals” guide rates UVA Health University Medical Center as “High Performing” in 5 adult specialties and 14 conditions/procedures. We are one of 70 National Cancer Institute designated cancer centers. UVA Health Children’s is named by 2023-2024 U.S. News & World Report as the best children's hospital in Virginia with 9 specialties ranked among the best in the nation. Our footprint also encompasses 3 community hospitals and an integrated network of primary and specialty care clinics throughout Charlottesville, Culpeper, Northern Virginia, and beyond.