Care Coordinator

**About Us**:
PRAXES Medical Group, headquartered in Halifax, Nova Scotia, has been a trusted provider of innovative healthcare solutions for over 28 years. In partnership with Nova Scotia Health, PRAXES operates the Mentor Clinic as a not-for-profit, collaborative primary care clinic built on the family health team model.

This approach places patients at the center of care and relies on strong teamwork within a inter-disciplinary team to deliver comprehensive, patient-focused services. We emphasize prevention, holistic health, and proactive care planning provided one-on-one and in groups, to support long-term well-being. Mentor Clinic continues to evolve and grow by taking patients off the Need A Family Practice Registry. Each newly added patient is scheduled for a detailed intake appointment, then follow-up with the most appropriate provider.

**Care Coordinator Role**:
The Care Coordinator is an essential member of Mentor Clinic’s interdisciplinary primary care team, supporting integrated, patient-centered care through a team-based model. Each Care Coordinator works closely within a clinical team and collaborates with the interprofessional team. Clinic staff composition can be found on the Mentor Clinic website.

The Care Coordinator builds trust through a supportive intake process using active listening and goal setting to understand patient priorities and social determinants of health. This insight informs referrals and ensures care plans align with patient goals while integrating provider expertise. By managing intake, triaging communications, and coordinating referrals and patient follow-up, the Care Coordinator smooths administrative processes so providers can focus on clinical care.

**Key Responsibilities**:

- Conduct empathic intake sessions that explore patient goals, values, and holistic health needs (not just focus on what’s wrong with them.)

- Identify and document social determinants of health in addition to any chronic and/or acute medical problems to inform care planning.

- Manage patient care journeys across clinical and interprofessional teams.

- Triage patients to ensure appointments are scheduled with the most appropriate practitioner, based on patient needs and team availability.

- Manage high-volume inbox communications using TELUS Electronic Medical Record (EMR), ensuring timely action on patient messages, referrals, and provider requests.

- Prioritize urgent issues, route tasks appropriately, and maintain clear documentation to support seamless care coordination.

- Collaborate with providers during team hurdles and case conferences.

- Track patient outcomes and contribute to quality improvement initiatives.

- Provide education and resources to empower patients in self-management.

- Ensure care is culturally sensitive, trauma-informed, and aligned with patient goals.

**Skills & Qualifications**:

- Knowledge of holistic healthcare including primary care, nutrition, physical activity, mental health, and more.

- Experience collaborating with or referring to interprofessional professionals (e.g., dietitians, exercise physiologists, OTs, mental health providers, physiotherapists).

- Background in care coordination, case management, and clinic-based primary care is preferred.

- Experience and/or training in health coaching, mental health, or coaching modalities (e.g. motivational interviewing) to support empathic, goal-oriented conversations with patients is a strong asset.

- Experience with TELUS EMR for inbox triage, task routing, and referral tracking is strongly preferred.

- Skilled in managing clinical inboxes and triaging patient communications in fast-paced settings.

- Excellent communication, organization, and problem-solving abilities.

- Committed to collaborative, team-based, and preventive care.

**Our Values**:

- **People -**People are our greatest asset. We value passion, drive, and commitment. In return we provide opportunities for personal and professional growth and development. We encourage self-care, balance, and making time for personal health and wellness, for both ourselves and the people we work alongside.

- **Agility -**We thrive on Agility; the confidence to adapt to change, as well as the safety to learn from trying, failing, pivoting, and trying again. Innovation requires expertise, risk, and safe supportive workplaces.

- **Caring -**We define Caring as empathy, compassion, and kindness, with each other and for the people we serve. Each of our clients is unique, with different needs and priorities - there is no ‘one size fits all.’ Caring requires awareness, acceptance, respect, inclusion, and humble self-confidence.

- **Trustworthiness -**Trustworthiness is the genuine and respectful approach we take in everything we do. Its core is personal integrity, which we define as “do the right thing, even when no one is looking.” Trust is the cornerstone of how we deliver consistent, reliable care to those in need.

**Commitments**:
**PRAXES** is