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Care Coordination

Our Care Coordination Team is here to fill in the gaps

Our Care Coordination Team is here to fill in the gaps

Navigating the healthcare system can be daunting and confusing. You may also have healthcare needs that require more attention than what can be done with follow-up visits. Our Care Coordinators are here to help! As an extension of your provider, our Care Coordination team is here to fill in the gaps in care that occur in the fragmented healthcare system.

We touch base with you to make sure your chronic conditions are well managed in between visits with your primary care provider through our Chronic Care Management program.

Ensure your referrals go through and you are connected to your specialists

Ensure smooth transitions of care from the hospital and emergency room back to your primary care doctor, ensuring you have the care you need post-discharge.

Connect you with members of our inter-disciplinary team including our Patient Educator, Lifestyle and Wellness Coach, Social Workers, and Behavioral Health professionals.

Ensure you have the medication you need and solve barriers that could prevent you from obtaining and taking your medication.

Make sure you have follow-up appointments scheduled according to your primary care doctor’s care plan.

And more! We listen to you and make sure your needs are met. It’s our job to break down the barriers between you and your care.