Care Coordinator

Behavioral Health Santo Domingo, New Mexico


Kewa Pueblo Health Corporation

PO Box 559  •  85 West Highway 22  §  Santo Domingo, NM 87052  §  (505) 465-3060 P  § 



Care Coordinator

Department:Behavioral Health

Reports to:Director of Behavioral Health

FLSA Status:Exempt

Type of Position:Full-Time

Revised Date:5/22/2024




The Kewa Pueblo Health Corporation (KPHC) is established for the purposes of carrying out the vision and mission of the Santo Domingo Health Center (SDHC). The MISSION of KPHC is:  “ENSURING HEALTH & WELLNESS THROUGH EXCELLENCE IN HEALTHCARE WITH RESPECT FOR CULTURE” and the VISION OF KPHC is:  “HEALTHY PEOPLE, HEALTHY COMMUNITY, and HEALTHY LIFESTYLE”.




The incumbent works under the direction of the Behavioral Health Manager or designee and works in collaboration and continuous partnership with chronically ill or “high-risk” patients and their family/caregiver(s), clinical/hospital/specialty providers and staff, and community resources in a team approach in accordance with HIPAA and other pertinent regulations and standards.




In the performance of their respective tasks and duties all employees of the Kewa Pueblo Health Center are expected to conform to the following:

  • Uphold all principles of confidentiality and patient care to the fullest extent.
  • Adhere to all professional and ethical behavior standards of the healthcare industry.
  • Interact in an honest, trustworthy, and dependable manner with patients, employees, and vendors.
  • Possess cultural awareness and sensitivity.
  • Maintain a current insurable driver’s license.
  • Comply with all Kewa Pueblo Health Corporation and Santo Domingo Health Center policies and procedures, as well




  • Serve as a contact point, advocate, and informational resource for patients, care team, family/caregiver(s), payers, and community resources.
  • Conduct home visits and outreach to Carelink NM patients and potential new program participants.
  • Complete comprehensive needs assessments on patients in the Carelink NM Program.
  • Serve on the integrated and interdisciplinary team that cares for Carelink NM patients.
  • Work with MCOs in researching, investigating, and reporting grievances, appeals and critical incidents involving a program participant.
  • Facilitate patient access to appropriate medical and specialty providers.
  • Educate patient and family/caregiver(s) about relevant community resources.
  • Facilitate and attend meetings between patient, family/caregiver(s), care team, payers, and community resources, as needed.
  • Cultivate and support primary care and specialty provider co-management with timely communication, inquiry, follow-up, and integration of information into the care plan regarding transitions-in-care and referrals.
  • Assist with the identification of “high-risk” patients (the chronically ill and those with special health care needs).
  • Actively participate in internal and community program meetings.
  • Serve as a member of the care coordination team which processes economic, social, emotional, mental, spiritual and cultural factors to enhance delivery of comprehensive health care.
  • Other duties as assigned.







  • Bachelor’s Degree in a health or social sciences field from an accredited institution of higher learning plus at least three years of experience working in a health or social sciences field (preferred); Associate’s Degree in health or social sciences from an accredited institution of higher learning plus at least four years of experience working in a health or social sciences field (accepted).



  •  Three - four years (depending on degree) of related work experience preferably in a clinical setting.




  • Basic Life Support (BLS) and CPR/First Aid Certifications preferred.



Mandatory Knowledge, Skills, Abilities & Other Qualifications:


          Excellent computer skills and knowledge of software and applications associated with general office administration, excellent communication skills, both written and verbal.

          Core values consistent with patient-and-family centered approach to care.

          Demonstrated skills in effective and tactful communication skills, including written, verbal and nonverbal.

          Demonstrated knowledge of patient rights on confidentiality issues, patient confidentiality and consummate practitioner of HIPAA guidelines and regulations.

          Verifiable experience as an effective patient advocate, responding with empathy and respect to resolve patient and family concerns, and recognize opportunities for improvement to meeting patient concerns.

          Proactively continues to educate self on providing quality care and improving professional skills.

          Knowledge and skill in using an electronic health record.

          Working knowledge of medical terminology and medical care practice and procedures.

          A record of satisfactory performance in all prior and current employment as evidenced by positive employment references from previous and current employers.




          Bilingual skills in English and the Keres native language.

          Basic Life Support (BLS) and CPR/First Aid Certifications preferred.

          Prior experience working with Indian Health Services (IHS), a Tribe or Tribal organization.

  • Prior work experience in a health care setting.




The work environment characteristics described here are representative of those an employee encounters while performing the primary functions of this job. Normal office conditions exist, and the noise level in the work environment can vary from low to moderate. Travel during the day time, as well as limited overnight travel may be required from time to time. This position may be exposed to certain health risks that are inherent when working within a health center facility.




The physical demands described here are representative of those that must be met by an employee to successfully perform the primary functions of this job. While performing the duties of this job, the employee may be required to frequently stand, walk, sit, bend, twist, talk, and hear. There may be prolonged periods of sitting, keyboarding, reading, as well as driving or riding in transport vehicles. The employee must occasionally lift and/or move up to 50 pounds. Specific vision abilities required by this job include reading, distance, computer, and color vision. Talking and hearing are essential to communicating with patients, vendors, and staff.




There are a number of deadlines associated with this position. The employee must also multi-task and interact with a wider variety of people on various and, at times, complicated issues. 





All employees must uphold all principles of confidentiality and patient care to the fullest extent. This position has access to sensitive information and a breach of these principles will be grounds for immediate termination.



Disclaimer:  The information in this position description has been designed to indicate the general nature and level of work performance by employees in this position.  It is not designed to contain or be interpreted as, a comprehensive inventory of all duties, responsibilities, and qualifications required of employees assigned to this position. Employees will be asked to perform other duties as needed.


Salary Range:  $61,834.00 to $92,751.00