LOCATION/DEPT.: Harrison Square – 605 S. Wolcott, Chicago, IL/Health Plan Services

SHIFT: 8:30AM – 4:30 PM (40 hrs/week)

Job Summary Union - NONE

The Population Health Coordinator provides care coordination services for individuals who need assistance to decrease risks and promote wellness. The work is through telephonic contacts and in- person visits in individuals' home environments, health care settings or other community settings and requires various assessment and intervention techniques. In collaboration with the individual, may develop a person-centered care plan. The Population Health Coordinator ensures completion of referrals, care planning activities, and self-directed goals and tasks.

Typical Duties

• Primarily manages individuals with chronic conditions or social determinant risk factors impacting care delivery or access.
• Provides periodic follow-up, reviews risk scores, and/or health information, monitors for changes in condition and coordinates services following emergency care or hospitalization.
• Utilizes evidence-based practices and health information to help individuals improve their specific conditions or health needs.
• Completes screenings and assessments, develops a person-centered care plan that recognizes the patient's risk level, priorities, individual preferences and medical needs based upon screening and assessment results.
• Evaluates progress made towards agreed upon goals.
• Transfers cases to Community Based Care Coordinators if individual has high risks requiring counseling interventions or ongoing medication reconciliation.
• Refers individuals to community-based resources in order to maintain levels of wellness in the individual’s community environment.
• Meets or exceeds timelines associated with case activities and completes activities according to department policy and procedures.
• Communicates effectively with Medical Home team and other care providers to support coordinated care.
• Provides succinct case summaries and collaborates with Interdisciplinary Care Team to develop the plan of care.
• Initiates reporting and conducts necessary follow-up of health, safety, and welfare concerns.
• Documents findings and activities in the Care Management System with completeness and accuracy.
• Identifies resources in the community that meet individual’s needs and support the care coordination program.
• Collaborates with and builds relationships with internal and external partners.
• Travels throughout the Cook County area.
• Performs other duties as assigned.

Minimum Qualifications

• Bachelor's degree or higher from an accredited college or university is required. (Must provide official transcripts at time of interview)
• A minimum of three (3) years of experience providing direct health, social or human services needs is required.
• A minimum of one (1) year of experience providing care coordination and/or individual facing interventions is required.
• Position may require travel for which the employee must have a valid driver’s license/insured vehicle or other equivalent means of transportation to arrive at field-based locations in an efficient manner (Must provide valid driver's license and vehicle insurance at time of interview)

Preferred Qualifications

• Certification from recognized credentialing source in care management, addiction counseling, child welfare, domestic violence, aging or disability or other related health and social service is preferred.
• Experience in serving a justice-involved population is preferred.
• Bilingual, preferred.

Knowledge, Skills, Abilities and Other Characteristics

• Thorough knowledge of practices, procedures. and techniques; medical terminology and procedures; and physical and mental health treatment services
• Excellent verbal and written communication skills to prepare written materials, correspond with administrative personnel, hospital personnel and the general public
• Strong interpersonal skills: demonstrated ability to work well with others
• Skill in conducting interviews
• Ability to communicate effectively verbally and in writing with diverse individuals of varied levels of education and health literacy
• Ability to formulate and develop social services procedures and standards
• Ability to partner with other team individuals effectively
• Ability to maintain the confidentiality of patient related materials in compliance with (Health Insurance Portability and Accountability Act) HIPAA requirement
• Ability to travel throughout the Cook County area
• Demonstrate interpersonal skills and be able to build relationships

• Medical, Dental, and Vision Coverage
• Basic Term Life Insurance
• Pension Plan
• Deferred Compensation Program
• Paid Holidays, Vacation, and Sick Time
• You may also qualify for the Public Service Loan Forgiveness Program (PSLF)

Please note all offers of Employment are contingent upon the following conditions: satisfactory professional & employment references, healthcare and criminal background checks, appropriate licensure/certifications and the successful completion of a physical and pre-employment drug screen.

CCHHS

is strictly prohibited from conditioning, basing or knowingly prejudicing or affecting any term or aspect of County employment or hiring upon or because of any political reason or factor.