Interdisciplinary Team Specialist

About myPlace HealthmyPlace Health was founded in 2021 by mission-aligned healthcare leaders and organizations that are committed to drastically improving health outcomes, quality and experience for vulnerable older adults and frail seniors. We specialize in providing value-based, comprehensive care and coverage for older adults with significant needs so they can thrive in the homes they love and in the communities they cherish.  Our mission is simple: to enable older adults to live the independent lives they deserve. We pursue this mission through our myPlace PACE (Program of All-Inclusive Care for the Elderly) model, which provides seamless primary care, integrated health plan coverage, personalized social engagement, and customized services delivered in the participant’s preferred place.   myPlace Health is building a mission-driven team that shares our passion for redefining the way older adults experience care as they “age in place” in the community. This is a unique opportunity to take on one of our country’s most challenging healthcare problems and join a fast-growing, dynamic team as we prepare to scale our mission to serve more markets. 
About This RoleDo you excel at fostering collaboration and accountability within interdisciplinary teams to truly align care with each individual’s unique values and goals? Are you excited about joining a mission-driven organization where your leadership can make a meaningful impact on the quality of life for our participants? Then we would love to have you our team!
We’re excited to welcome an experienced and passionate Care Team Specialist to our growing organization. In this vital role, you’ll work closely with our Center Director and lead an 11-discipline Interdisciplinary Team (IDT) to ensure our participants receive the highest quality care. Your leadership and experience will play a key role in facilitating Interdisciplinary Team Meetings, ensuring we meet all regulatory requirements, and fostering a collaborative, accountable environment that truly aligns with each participant’s values, goals, and preferences.
If you’re driven by a desire to improve the quality of life for others and thrive in a team-centered, mission-driven environment, we’d love to have you join us!

What Does Success Look Like In This Role?

• Person-Centered Collaboration – Work closely with our interdisciplinary team to understand and honor each participant’s goals, values, and preferences, ensuring care plans reflect what matters most to them.
• Clinical Framework Application – Embrace and apply the principles of Patient Priorities Care and Goal Concordant Care, guiding our approach to delivering compassionate, individualized care.
• Meeting Facilitation – Lead and facilitate Care Team Meetings, morning huddles, and care planning discussions, capturing all relevant details clearly and accurately in our Electronic Medical Record (EMR).
• Workflow Optimization – Design and maintain efficient workflows for care planning, documentation, and compliance, ensuring alignment with regulatory standards and high-quality care delivery.
• EMR Expertise – Serve as a go-to expert in our EMR system, offering hands-on support and guidance to team members so they feel confident and capable in their documentation responsibilities.
• Task Management – Monitor and ensure timely completion of assessments, care plans, service determinations, and other IDT-related processes, keeping everyone on track and in sync.
• Scheduling Support – Provide backup support to the Scheduling Coordinator, helping ensure assessments are completed within required timeframes, especially during high-volume or transition periods.
• Quality & Compliance Partnership – Collaborate with our Quality Improvement and Compliance teams to regularly audit care plans and uphold regulatory excellence across all documentation.
• Team Coaching – Offer supportive coaching and help nurture a culture grounded in accountability, teamwork, and continuous improvement.
• Whole-Person Care Support – Step in to assist wherever care is needed—physically, emotionally, and spiritually—meeting participants and colleagues with compassion and commitment.
• Adaptability – Contribute to broader team success by taking on additional responsibilities as needed to support the continued growth and evolution of our IDT model.

What Does An Ideal Candidate Look Like?

• Mission-Driven Mindset – A deep passion for serving high-risk seniors and frail older adults, with a heart for making a difference every day.
• Adaptability – Thrives in a fast-paced, dynamic environment and embraces a culture that values collaboration, teamwork, and continuous learning.
• Person-Centered Care Orientation – Brings a strong focus on what