Under the direction of the Panel Manager, the PCMH Care Coordinator is part of the primary care practice team and is responsible to assist with coordinating population health services to patients within the practice who are at most risk for health deterioration or poor outcomes. The PCMH Care Coordinator’s role is to improve health outcomes through health coaching and education, building the medical home between patients and practitioners and enhancing communication and continuity of care. The PCMH Care Coordinator works with the Care Team to increase patient’s access to services and healthcare resources thereby, supporting patient’s self-care goals.