The Community Care Coach (CCC) will primarily be working out in the community with specific target populations, teaching the necessary tools for patients to properly navigate the healthcare system, encouraging the adoption of habits that are conducive to a higher quality of life, and implementing programs designed to increase overall health. The CCC will work under the guidance of the RN or SW to conduct and document biometric screenings, help patients/clients in utilizing resources and accessing health related services, coach patients/clients in effective management of health conditions, and will assist in following up with health management/care plans with both patients and providers. The CCC will work closely with medical providers, primary care teams, and other agencies to improve communication, services, patient care, and outcomes.
Patient Care * Ability to perform home visits as needed. * Demonstrates ability to check patient vital signs including temp, BP, pulse, pulse oximetry and report to RN. * Demonstrates the ability to assess living environment and subjective symptoms to objectively identify if a patient has a need or issue; reports to RN or SW as needed. * Supports and reinforces nursing care plan and education. * Demonstrates ability to collaborate with care management team and other community agencies in support of patient care. * Follow up with patients post hospital visit and PRN visits. |
Communication and Documentation * Provides coaching and/or teaching to patients and family members. * Establishes relationships with patients/clients and provides positive and supportive feedback. * Demonstrates the ability to utilize EMR for documentation and communication purposes. * Demonstrates the ability to collaborate with other professionals, patients and their family members. |
Care Management * Possesses and demonstrates knowledge of community resources available (Flagstaff/ Verde Valley) area. * Completes follow-up phone calls and assists patients with scheduling appointments with providers and other agencies. |
Compliance/Safety * Responsible for reporting any safety-related incident in a timely fashion through the Midas/RDE tool; attends all safety-related training programs; performs work in a safe manner; monitors work environment for possible safety issues and ensures others are also performing work in a safe manner. * Stays current and complies with state and federal regulations/statutes and company policies that impact the employee's area of responsibility. * If required for the position, ensures all certifications and/or licenses are up-to-date and valid prior to expiration dates. * Completes all company mandatory modules and required job-specific training in the specified time frame. |
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