Disease Management Care Coordinator
Compass Health Network

Job Info

Compensation: $15.00 hourly


The Disease Management Care Coordinator is responsible for gathering, researching, analyzing and reporting data for the Disease Management Program.


• Process and utilize new DM cohorts to ensure all identified clients are ready to be outreached
• Send newly identified DM clients an initial DM introduction letter and send a letter to all such client’s Primary Care Provider informing them that their patient has been identified for DM
• Contact DMH to notify of a client transfer or the death of a client
• Review Cyber Access for hallmark events and inform staff when such events are identified
• Maintain accuracy of information for all DM Outreach clients by cross checking multiple software systems
• Communicate effectively with DM Outreach staff, assisting with their requests and passing relevant information along to them to enable efficient outreach
• Assist with DM Outreach reports each month
• Cross check multiple software systems for data accuracy and proper implementation
• Provide data and/or reporting to Director of Access and Urgent Care and ERE Supervisors and ERE Staff
• Analyze various metrics and measures providing the reports and charts for Senior Management.
• Gather and process all necessary client information for monthly enrollments, transfers and discharges, including insurance and spend down verification. Ensure all state requirements and standards are met before submitting to DMH
• Complete daily hospitalization reports which require research and verification before forwarding to behavioral health staff
• Maintain hospitalization tracking system by accessing multiple hospital portals to monitor HCH client admissions and discharges; communicate findings with DM outreach staff, ERE supervisors and Director.
• Research and obtain Outreach client data for contact and re-engagement of services
• Generate reports for auditing purposes and perform analytical examination of data identifying positive and negative trends.
• Assist with overall data extraction, interpretation and analysis from various management systems to maintain integrity of data
• Ongoing reporting and verification of various information to ensure data quality
• Other duties as assigned


• Regularly attends work except for approved absences
• Attends all training as required
• Maintain professional, “champion” behavior
• Provides quality customer service
• Provides services with a commitment to service excellence
• Works in a way that exhibits a commitment to personal excellence
• Team oriented and values diversity




• Analytical Thinking
• Change Readiness
• Collaborative Relationships
• Conflict Resolution
• Creative Thinking
• Communication – Oral
• Communication – Written
• Decision Making
• Empowers Others
• Leadership
• Multitasking/Planning
• Organizational/Time Management
• Problem Solving
• Project Management
• Teamwork


• High School/GED required
• Associate/Bachelor’s degree preferred


• At least three (3) years’ experience similar to the essential job functions listed above preferred
• Proficient knowledge of all Microsoft Office suite applications preferred
• Knowledge and experience in creating/running Crystal reports into Excel formats preferred


Compass Health is an Equal Opportunity/Affirmative Action Employer and an E-Verify participant. 

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