Primary Function-The Care Coordinator will coordinate team-based care to provide health services and education to patients and families through effective partnerships with Kidwell practices, community resources and medical professionals. Provides Care Coordination in the Kidwell practice setting by utilizing critical thinking skills and social worker expertise to optimize patient outcomes amongst designated populations within the practice. Works with patients and families to ensure both behavioral and psychosocial needs are met. Works with Kidwell practices to address gaps in care and promotes timely access to appropriate care, increasing the utilization of preventative care and healthy behaviors to improve the health of the population at risk