Health Homes Care Coordinator

Helping children, youth, young adults, and their families find their path to healing and hope is at the core of our work. We can only achieve this by striving for excellence and providing an array of services that are needed and wanted by the community we serve. We are continuing to expand our service array and locations where we provide services, with therapists in more schools and social service agencies. As we expand our services to serve more than 800 children, youth, and young adults each month – regardless of payer, gender identity, sexual orientation, race or ethnicity, or place of origin – we do so with the intention that we would want our own families to use these services should they need them. The staff at Ryther are committed to creating and maintaining a culture that is informed and reflective of trauma recovery and racial equity and social justice principles.


The Health Homes Care Coordinator provides comprehensive community-based case management and care coordination to eligible clients with behavioral health and physical healthcare needs.


  • Responsible for managing and ensuring coordination of care for eligible individuals.

  • Engage in outreach to assigned beneficiaries by phone, mail, email, and in-person to discuss the program and enroll the beneficiary in services.

  • Document all encounters with beneficiaries of the Health Home program in databases completing all paperwork accurately and within required timelines.

  • Conduct screenings and assessments to assist in the identification of health risks, barriers to healthcare access, behavioral health, and social needs.

  • Design relevant Health Action Plan goals and objectives that are time limited, enrollee-centric, strengths-based, and assist clients to improve health outcomes.

  • Provide five core Health Home services to enrolled clients:

    • Comprehensive care management,

    • Care coordination,

    • Health promotion,

    • Comprehensive transitional care,

    • Individual and family support, and

    • Referrals to community and social supports

  • Coordinate and ensure timely communication with service providers and partners across systems including healthcare workers, case managers, social workers, school staff, and other entities to meet the needs of clients and families.

  • Maintain appropriate personal and professional boundaries with clients, families, co-workers, and community resources. Approach clients in a family-centered and culturally competent manner that reflects the agency and program philosophy and values.

  • Maintain case records in accordance with licensing, accreditation, contract, and agency requirements.

  • Attend, participate in, and appropriately utilize care management consultations.   

  • Maintain all necessary credentials per agency and licensing requirements.

  • Demonstrate a high degree of skill in communication and positive interaction with all Ryther employees, prospective employees, external agencies/companies, and the community at large.


  • Commitment to the Purpose, Vision, and Values of the agency.

  • Acceptance of a variety of lifestyles, behaviors, cultural, and spiritual practices.

  • Be at least 21 years of age.

  • Accredited Bachelor’s Degree in social work or related field and two years relevant experience preferably in case management with children and families.

  • Valid Washington state driver's license and automobile liability insurance.

  • Ability to maintain awareness of culturally relevant issues while interacting with children, families, co-workers, and community members.

  • Ability to work with a strengths-based model.

  • Understanding of family systems and family-centered practice principles.

  • Understanding of child development, child psychology, and basic understanding of psycho-pharmacology.

  • Awareness of the healthcare system, public mental health system, and community resources.

  • Knowledge and understanding of case management practices.

  • Ability to operate as a member of an interdisciplinary treatment team.

  • Ability to exercise discretion and maintain customer and employee confidentiality.

  • Effective written and verbal communication skills.

  • Flexibility and ability to work a varied schedule including evenings and weekends.

  • Ability to spend face to face time with beneficiaries each month in the community.

  • Computer word processing skills and familiarity with EHR systems.

  • Ability to perform a range of physical motions including but not limited to:

    • lifting and carrying up to 50 lbs.,

    • standing, walking, sitting for long periods of time,

    • kneeling, squatting, and stooping,

    • running for brief periods of time,

  • The ability to address and resolve conflict in a professional manner.


Main Office

2400 NE 95th St, Seattle, WA 98115

Main Phone


For Appointments
New Clients: 206.379.4642 

Current Clients: 206.799.2573
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