Care Coordinator II

Sea Mar Community Health Centers
, a Federally Qualified Health Center (FQHC) founded in 1978, offers comprehensive health, human, housing, educational, and cultural services to diverse communities, specifically serving Latinos in Washington State. All persons are served without regard to race, ethnicity, immigration status, gender, or sexual orientation, regardless of ability to pay.

Position: Care Coordinator II (Full-time)

Hourly Rate: $22.63

Sea Mar requires mandatory COVID‑19 and flu vaccinations for all employees.

Full‑time position at Everson Medical Clinic. The Care Coordinator will coordinate care for patients with chronic conditions and behavioral health needs at the point of care. As a member of the Clinical Care Team, the Coordinator will participate in daily huddles, identify patients’ needs according to protocols, and provide point‑of‑care services to enhance quality and patient‑centered care.

• Participate in morning huddles to anticipate patients’ clinical, social and behavioral health needs.
• Collaborate with the care team to identify gaps in care and implement process‑improvement strategies.
• Provide brief interventions at the point of care to help patients manage chronic illnesses, address social needs, and link to behavioral health resources.
• Advocate for patient services with community, social service, and medical providers.
• Coordinate care transitions for patients discharged from hospitals, ERs or long‑term care facilities.
• Track patients’ adherence to the plan of care in electronic or paper charts and communicate outcomes and recommendations to the primary care provider.
• Act as the point person on chronic disease management and quality improvement activities to improve clinical quality measures.
• Organize monthly Health Home meetings, create agendas and facilitate meetings.
• Collaborate with the clinical care team to improve Patient‑Centered Medical Home processes and provide documentation of performance.
• Review medical records for quality and utilization indicators as outlined in the Quality Improvement Plan.
• Generate reports for care teams to identify improvement areas and monitor sustainability of each quality measure.

• Ability to work independently, prioritize workload, and meet deadlines.
• Critical thinking skills and discretion to maintain confidentiality.
• Excellent organizational skills and ability to manage multiple tasks simultaneously.
• Knowledge of medical terminology and/or behavioral health topics.
• Strong decision‑making and prioritization abilities.
• Respectful and professional interaction with community, patients, families, and staff.
• Effective work in a multicultural environment with a diverse population.
• Sympathetic, mature, responsible, and reliable.
• Strong patient engagement, interpersonal, and communication skills to establish therapeutic relationships.

• Knowledge of the Patient‑Centered Medical Home model and motivational interviewing skills is a plus.
• Familiarity with evidence‑based standards of care for chronic conditions and behavioral health.
• Proficiency with Microsoft Word, Excel, PowerPoint, and Outlook.
• Ability to document patient information in the Electronic Health Record.
• Knowledge of community resources.
• Comfortable working in a fast‑paced community health care setting.
• Analytical and problem‑solving skills in multidisciplinary and independent contexts.
• Effective communication with diverse communities.
• Time‑management and task‑prioritization.
• Analysis of patient care data.
• Assessment of client learning needs and knowledge readiness.
• Maintenance of privacy and security of sensitive information per local, state, and federal privacy requirements.
• Excellent communication and customer‑service skills.
• Critical thinking.
• Process improvement implementation.
• Spanish language fluency is strongly preferred; other language skills considered based on site needs.

• LPN with experience in ambulatory care, or BA/BS/BSW in health‑related field with one year of community health experience, or four years of equivalent experience (no active…