Care Coordination

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What do Care Coordinators do? 

Care Coordinators help their patients create a care plan and help them get started by reviewing service needs and goals.  Care Coordinators make sure that their patient’s doctors, specialists and providers are communicating with each other about their patient’s needs.  Care Coordinators also help patients navigate the healthcare system — from finding providers and scheduling appointments to arranging for additional needed services — to ensure their patients have what they need to follow their care plan.

What kinds of things do Care Coordinators help people with?

  • finding a doctor or specialist
  • making sure doctors are talking to each other about the patient and their care
  • advocating for the patient
  • helping the patient understand and remember confusing information
  • scheduling appointments, tests and more
  • getting transitional care after discharge from the hospital
  • getting into mental health or substance use programs
  • linking with transportation resources

Care Coordinators understand and have access to social services. We help patients find out what they're eligible for and enroll in those services. 

Care Coordinators help people:

  • apply for financial services and entitlements through DSS, SSA, HEAP and more
  • find education or job training programs
  • get nutrition counseling and food pantry items
  • link with housing assistance programs
  • access additional community and social support
  • prepare for life changes