Care Coordinator-Nursing Services

Vista Community Clinic is a private, non-profit, multi-specialty outpatient clinic providing care in a comprehensive, high quality setting. Located in San Diego, Orange and Riverside counties, we work to advance community health and hope by providing access to premier health services. We are looking for dedicated, motivated, enthusiastic team players who want to make a difference in the community. Our competitive compensation and benefits program includes health, dental, vision, company-paid life, flexible spending accounts and a 403(B) plan, for eligible employees. VCC is an equal opportunity employer.

• Utilize the PCMH model to provide coordinated team care that addresses current health issues, preventive care and health maintenance follow-up to improve health outcomes and reduce health disparities
• Provide end of visit interviews, process referrals for outside agencies and specialists, initiate patient engagement conversations as directed by the Clinicians, documenting in the patients progress note or Care Plan
• Coach patients using positive reinforcement and encouragement and a flexible approach to address critical issues to help patients develop achievable self-management care plan goals, presenting new skills using a step-by-step process
• Act as point of contact for patients and families asking questions or raising concerns through the patient portal, or via telephone and/or texting
• Use motivational interviewing to gather patient information and understand barriers from the patients view to enhance efforts to engage, educate and empower behavior changes
• Assist in recruiting individuals for participation in educational programs
• Reinforce information given to the patient and/or family with handouts to improve patient self-management skills and communication
• Assist in data collection, data entry, and evaluation processes
• Assist in the development of a wide range of materials such as educational curriculum, fliers and news releases
• Perform population management tasks such as appointment scheduling, prevention and screening recalls, patient portal callbacks and responding to telephone messages
• Compile written reports as needed
• Attend mandatory in-service training sand related meetings, providing feedback on the content of those attended
• Serve as representative at professional meetings as needed
• Serve as a liaison between program and community
• Assist in planning, developing and implementing program strategies
• Enhance professional growth and development through participation in educational programs, current literature review, in-service meetings and workshops

Minimum

• High school graduate or equivalent
• Certification/minimum two years education in chronic disease/health
• Bilingual English/Spanish

Preferred

• Medical Assistant experience preferred working with the medical home concept or for a non-profit community health clinic

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