Care Coordinator

About this role

Job Title: Care Coordinator

Department: Product Delivery

About the Role :

The Care Coordinator supports customers by using the Unite Us Platform and providing the support and guidance needed to deliver high-quality Care Coordination. Care Coordinators are platform experts who interact directly with clients seeking services and with the partners that provide resources and support to Care Coordination customers’ clients.Care Coordinators conduct client needs assessments and assist clients in identifying social determinants of health resources to meet their needs. Care Coordinators also follow up with clients and resources to ensure identified needs are addressed and resolved. Care Coordinators also support Network Health Monitoring by combining platform expertise, referral support, and data-informed insight to help strengthen coordinated care networks and improve community outcomes. This includes monitoring network activity, reviewing key performance indicators, identifying referral trends, supporting partner responsiveness, and flagging potential gaps or barriers that may impact care coordination across healthcare providers, government agencies, and community-based organizations. By combining on-the-ground care coordination with network-level visibility, Care Coordinators surface insights that improve referral outcomes, strengthen network performance, and enhance the experience for clients, customers, partners, and internal teams. Care Coordinators contribute to cross-functional work groups and projects, and help identify opportunities to improve efficiency and enhance the Care Coordination experience for clients and teammates alike.

What You'll Do :

Client Intake, Outreach & Screening

• Follow contractual requirements for Care Coordination customers' clients seeking assistance in areas such as housing, transportation, health, employment, benefits, financial assistance, and other services.

• Conduct intake and needs assessments for clients seeking assistance.

• Using data from Unite Us' proprietary social connector/population insights tools, proactively reach out to clients identified as likely having social or health-related needs, conduct screenings, and connect them with resources, such as housing, transportation, health, employment, benefits, financial assistance, and other services

Referral & Care Coordination

• Connect clients with the most appropriate services based on individual needs, eligibility, and geographic preference, informed by first-hand knowledge of the provider network, not just a generic resource list.

• Monitor customer and partner referrals to support timely action, appropriate outcomes, and successful client connection to services.

• Conduct follow-up with clients and service providers to confirm receipt of services/benefits, and, where applicable by contract, work with clients toward their health goals to ensure recommended actions are completed.

• Correspond directly with service providers to facilitate a seamless experience for clients navigating services.

Network Relationship Management & Network Health Monitoring

• Build and maintain working relationships with CBOs and other providers on the Unite Us platform, serving as a trusted point of contact and a resource for the network.

• Provide supportive, constructive feedback to CBOs serving Care Coordination clients to ensure network standards are met.

• Own Network Health Monitoring responsibilities: identify referral trends, partner responsiveness concerns, service gaps, and workflow barriers that could impact care coordination outcomes.

• Proactively engage CBOs to clean up and maintain accurate referral data and organization records on the platform, ensuring the network remains reliable and up to date.

• Share network observations, referral barriers, and partner engagement insights with leadership and cross-functional teams to support network health, customer goals, and continuous improvement.

Platform & Subject-Matter Expertise

• Continuously expand knowledge of national and local community resources, services, and programs to deepen understanding of community needs and build relationships with other users of the Unite Us platform.

• Maintain strong working fluency in the Unite Us platform and its tools, including TalkDesk (Unite Us' telephony partner) for making and receiving client calls.

Team Collaboration & Performance

• Work and produce exceptional results independently, with little oversight or direction.

• Consistently go above and beyond in supporting customers and contracts.

• Identify and promote opportunities for improved efficiency or other enhancements that benefit the Care Coordination team at large.

• Regularly contribute to additional workgroups, special projects, training/enablement, and cross-department meetings when called upon by leadership due to consistent high performance and reliability.

• Exceed department KPIs related to quality assurance, meeting customer goals/expectations, delivering high-caliber customer service, and efficiently managing referrals and call volume.

• Regularly support fellow Care Coordinators to ensure contractual obligations (call volume, response time, etc.) are met or exceeded. Care Coordinators support contracts as a team, and collaborating to meet shared deadlines and expectations is a regular expectation, not an exception.

You are a great fit for the role if:

Education

• No specific education requirements. Relevant experience and skills will be prioritized.

• Board-certified case manager (CCM®) or the ability to obtain certification is a plus

• Bilingual Spanish a plus

Experience

• Experience in a Care Coordinator, Care Navigator, case management, community health worker, social work, or related role preferred

• Experience navigating social services, coordinating referrals, or supporting clients in areas such as housing, transportation, health, employment, benefits, financial assistance, or related needs preferred

• Exp

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