Complex Care Coordinator

Who We Are

Central Vermont Home Health & Hospice is a full service, not-for-profit Visiting Nurse Association committed to providing high quality, medically-necessary home health and hospice care to all central Vermonters, regardless of a person’s ability to pay. In addition, we promote the general welfare of all central Vermonters with health promotion, long term care, and maternal-and-child health services.

Who You Are 

• You have well developed interpersonal communication and organization skills.
• You possess comprehensive knowledge of chronic health conditions.
• You are versed in how to navigate the health care system including community resources.
• You are able to quickly identify and prioritize patient needs and provide structured and focused support and interventions.
• You have the ability to be flexible and adaptable to change and respond in a constructive manner.
• You have sound critical thinking and creative problem-solving skills.
• You enjoy working collaboratively and in a productive manner with Primary Care Providers, peers, subordinates, and managers, as well as the general public required.

If this is you, read on & apply!

Your Day-to-Day

• Serve as the program leader and point of contact for CVHHH’s Care Coordination program with OneCare Vermont (OCV), an Accountable Care Organization (ACO).
• Participate in OCV local and statewide Care Coordination Core Team meetings and other meetings with community partners as considered appropriate.
• Collaborate with CVHHH visiting staff (case managers) and other community partner contacts on care coordination activities for CVHHH patients that are attributed to the related OCV patient panel.
• Ensure effective communication between CVHHH and members of the external health care team to support care coordination activities and goal attainment.
• Document care coordination activities that are pertinent to the CVHHH patient plan of care in the CVHHH electronic medical record.
• Work closely with the clinical care teams to assist with care coordination for patients.
• Participate in CVHHH clinical team huddle calls and case conferences, as necessary.
• Oversee the Longitudinal Care Program and Community Health Workers.
• Maintaining compliance with reporting for all ACO programs.

Your Benefits

• 28 days combined paid time off in your first year (with sell back option).
• Group health, dental, and life insurance, as well as long-term disability.
• Tuition reimbursement for career advancement and continuing education.
• Student loan repayment assistance.
• Qualified Employer for Public Service Student Loan Forgiveness Program.
• Discounts at local vendors.
• A hybrid work schedule

Requirements – Complex Care Coordinator

• Must hold valid licensure as Registered Nurse, Physical Therapist, Occupational Therapist or Speech Therapist.
• Minimum of 5 years’ experience in case management and care coordination in a clinical or outpatient setting, or a combination of education and experience from which comparable knowledge and skills are acquired.  Community or public health experience preferred.
• Valid driver’s license