This program assists individuals with serious and complex health care challenges to navigate large health care systems and find the resources they need to meet their health goals.

Care Coordinators work side by side with their clients on health and healthcare goals identified as most important to them. Care Coordinators can work with clients for as long as necessary to help their clients improve their health and make the best use of the healthcare system. Serving Island, San Juan, Skagit, and Whatcom Counties.

Health Home Care Coordination

Health Home care coordination is provided by a skilled professional who will help you make the best use of the services and supports you currently receive, as well as assist in helping you to find others that may benefit you. Health Homes services are designed to support you with your ongoing chronic conditions and help you meet the health goals you select. Health Home services improve coordination of medical and social services needs such as long-term care, mental health, medical specialists, and housing. They assist with such activities as: transition planning when you leave a hospital or care facility; referral to community and social supports, such as transportation and food resources; and coordinating better communication between your medical providers, family, and other caregivers.

Recovery Care Coordination

In Skagit County, NWRC has Care Coordinators specialized in supporting people living with chronic substance use and mental health challenges. The goal is to support you in navigating the services you need on your path of recovery. Your Care Coordinator can work with you long-term toward goals that are developed by you. They know how to make things go more smoothly between your medical and social service providers. This means you will get the right care, feel better about your health, and reduce your contact with the legal system and hospitals. This program is free to those who need it and are living in Skagit County.

Hospital Care Coordination

A hospital stay can lead to many changes that are often overwhelming or seem impossible to cope with. A Hospital Care Coordinator can work alongside you to help problem-solve and come up with a plan to follow through with your discharge instructions that will fit with your lifestyle and personal goals. The Care Coordinator can visit you in your home after you are discharged to make sure the plan is going well. There is no time-limit and no cost to you. The goal is to bridge communication between the many agencies you may be connected to, solve the puzzle of medication changes, and support you around your discharge instructions and longer-term health goals.