Now Hiring:
Care Coordinator

Holy Cross Medical Center is hiring a full-time Care Coordinator to support perinatal clients and their children. This day-shift Support Services position works with clients in medical facilities, homes, and community settings to identify needs, overcome barriers to care, and connect families with essential healthcare and social services.

About the Role

The Care Coordinator develops trusting, client-centered relationships with families and helps them navigate healthcare, social services, and community resources. Using a strengths-based and trauma-informed approach, the Care Coordinator conducts comprehensive assessments, develops individualized care plans, coordinates referrals, and supports clients as they work toward their health and wellness goals.

Responsibilities

• Meet with perinatal clients and their children in medical clinics, hospitals, client homes, and community settings based on client preference
• Enroll and engage clients in the Care Coordination model
• Complete Health Risk Assessments, Comprehensive Needs Assessments, and Comprehensive Care Plans
• Collaborate with clients to establish SMART goals that are specific, measurable, achievable, realistic, and timely
• Assess social, material, and healthcare needs and help clients overcome barriers to health and well-being
• Explain available medical and social services, referral options, programs, benefits, and eligibility requirements
• Coordinate referrals and confirm that services were received and covered by the client’s insurance
• Help clients address transportation, lodging, childcare, and other barriers to attending appointments
• Encourage participation in perinatal home visiting, parenting education, breastfeeding support, advance care planning, disaster preparedness, and other beneficial programs
• Develop partnerships with healthcare providers, social service agencies, and other community organizations
• Accompany and support clients during medical, behavioral health, and social service appointments when appropriate
• Assist with Medicaid and other transportation and lodging requests
• Help clients set up, test, troubleshoot, and use home telehealth technology
• Maintain a caseload of 32 to 40 active clients
• Collect, document, and report required client information accurately and consistently
• Maintain electronic and paper records in compliance with HIPAA
• Identify safety concerns and follow appropriate guidelines for education, intervention, and the reporting of abuse or neglect
• Participate in clinical team meetings, case conferences, trainings, professional networks, continuing education, and conferences
• Work with supervisors, auditors, payers, clinics, and billing departments to support Care Coordination contracting and billing
• Implement feedback from supervisors, program auditors, and insurance billing departments
• Complete other duties as assigned

Requirements

• Experience: Experience in social services, healthcare, or a related field
• Education: Bachelor’s degree
• Skills & Qualifications:
  • Knowledge of maternal and child health issues
  • Knowledge of and shared lived experience with the community served
  • Understanding of client-centered, empathetic, strengths-based, health-literate, trauma-informed, and stigma-free care
  • Understanding of evidence-based behavior change practices
  • Ability to help clients identify and build upon their needs, goals, strengths, and abilities
  • Understanding of how social determinants of health affect health outcomes, health equity, and social justice
  • Ability to assist clients with home telehealth technology
  • Experience with detailed data collection and reporting through an online database
  • Knowledge of community outreach, partnership development, and referral management
  • Ability to follow the prescribed Care Coordination model with full fidelity
  • Comfort discussing sensitive personal matters and working with clients from diverse backgrounds
  • Ability to provide culturally, linguistically, and developmentally appropriate services
  • Commitment to becoming certified as a New Mexico Department of Health Community Health Worker within one year of hire, if requested

Preferred Qualifications

• Two or more years of experience in social services or a relevant healthcare setting
• Bilingual in English and Spanish