Job Description - Family Practice Care Coordinator Compassion Health Toledo
OUR MISSION
To provide compassionate, high-quality, affordable healthcare that reflects the love of Jesus.
Job Title :
Family Practice Care Coordinator Reports To :
Medical Director or Designee FLSA Status:
Non-Exempt Job Class :
Clinical Support Schedule :
Part-Time, 24-30
Hours Weekly Updated :
September 16, 2026 Position Summary The Family Practice Care Coordinator supports patients and the primary care team by helping patients navigate referrals, follow-up care, and services that address social determinants of health. The Care Coordinator works closely with providers, clinical staff, Community Health Workers, behavioral health staff, and community partners to reduce barriers to care and improve continuity. This position coordinates referrals, tracks follow-up needs, connects patients to resources, and helps ensure patients can access the services recommended by their care team. Essential Duties & Responsibilities Coordinate internal and external referrals for Family Practice patients, including specialty care, diagnostic services, behavioral health, and community-based services. Assist patients with scheduling referral appointments and provide information regarding appointment requirements, locations, and next steps. Track referrals from initiation through completion and follow up on outstanding appointments, reports, and recommendations. Communicate referral status and relevant updates to providers and Care Team members and document activities in the electronic health record (EHR). Identify barriers that may prevent patients from completing recommended care and work with the patient and Care Team to develop practical solutions. Screen for and help address social determinants of health, including food, transportation, housing, utilities, insurance, financial barriers, and safety needs. Connect patients with appropriate community programs, social services, financial assistance resources, and internal Compassion Health Toledo services. Collaborate with Community Health Workers, behavioral health staff, financial navigation staff, and other team members when additional support is needed. Assist with follow-up after emergency department visits, hospitalizations, specialist visits, or other transitions of care as requested. Support patients in understanding care plans, referral instructions, and recommended follow-up while remaining within the role's scope of practice. Help close care gaps through outreach related to preventive services, chronic disease follow-up, missed appointments, and other Care Team priorities. Maintain accurate, timely, and confidential documentation of referrals, patient contacts, resource connections, and care coordination activities. Develop and maintain knowledge of local community resources and referral partners. Participate in staff meetings, Care Team meetings, quality improvement activities, and training as requested. Adhere to all policies and procedures related to confidentiality, HIPAA, patient safety, and organizational compliance. Perform other duties as assigned by the Medical Director or designee. Qualifications High school diploma or equivalent required; associate or bachelor's degree in healthcare, social services, public health, or a related field preferred. Previous experience in primary care, care coordination, community health, referrals, social services, or patient navigation preferred. Knowledge of community resources and social determinants of health strongly preferred. Strong organizational, written, verbal, and follow-up skills. Skills & Competencies Commitment to Compassion Health Toledo's mission and values. Compassionate, patient-centered approach to care coordination and problemsolving. Effective teamwork, organization, and communication within a multidisciplinary Care Team. Knowledge of social determinants of health, community resources, and electronic health record (EHR) systems. Physical Demands & Work Environment Regularly required to sit, stand, walk, use a computer, and communicate effectively. Occasional lifting up to 25 pounds. Clinical and office environment with frequent patient and staff interaction. EEO & Compliance Compassion Health Toledo is an equal opportunity employer. We value diversity and are committed to creating an inclusive environment for all employees. All staff members are expected to maintain confidentiality, adhere to HIPAA guidelines, and complete all required compliance and safety training.
