Care coordination

Comprehensive Care Coordination at Every Step

Seamless support for your complete healthcare journey.

about care coordination

Your health journey involves multiple touchpoints.

Your health journey involves multiple touchpoints—regular checkups, specialist visits, medication management, and ongoing wellness support. Whether you need information, have questions about a topic of concern, require a virtual provider visit, or prefer to visit the clinic in person, we offer a full range of care to meet your needs. Even if you are hospitalized, we continue to communicate with your caregivers, advocating for you to ensure you feel supported and well-cared for.

OUR MISSION

How We Work

STEP 1

Understanding Your Needs

Comprehensive assessment

We begin by thoroughly evaluating your current situation to identify your needs.

Goal setting

Together, we establish clear and achievable goals that guide our efforts

Risk evaluation

We assess potential risks to ensure your care plan is safe and effective.

STEP 2

Creating Your Care Plan

Personalized strategies

Based on our assessment, we develop tailored strategies that align with your goals.

Resource Alignment

We identify and align necessary resources to support your care plan.

Timeline development

A clear timeline is established to track progress and milestones.

STEP 3

Ongoing Coordination

Regular monitoring

Based on our assessment, we develop tailored strategies that align with your goals.

Proactive adjustments

If needed, we proactively adjust the plan to meet your evolving needs better.

Continuous support

Our commitment to you includes ongoing support to help you achieve your goals.

Why Care Coordination Matters

The healthcare system can be overwhelming. Multiple appointments, referrals, and test results can make even simple care plans feel scattered. That’s where we step in.

With Serefin, you gain:

A Dedicated Advocate:

Your care coordinator is your personal health ally — someone who listens, translates medical jargon, and makes sure your voice is heard in every conversation. We help you ask the right questions, understand your choices, and make informed decisions about your care.

A Personalized Health Plan:

We work with you to create a plan that connects your health goals with your medical care and daily life. Whether you’re managing a chronic condition, preparing for surgery, or striving for better long-term wellness, we make sure every piece fits together seamlessly.

Ongoing Support Through Change:

Health isn’t static, and neither is life. When new needs arise, we adjust your care plan, connect you with the right specialists, and coordinate follow-up appointments so your care never falls through the cracks.

Confidence and Clarity at Every Step:

When you know someone is managing the details, you can focus on healing. We make sure your care feels connected, consistent, and human — because peace of mind is part of good medicine.

Your Integrated Care Coordination Team:

Healthcare works best when it's collaborative. Care coordination isn't managed by a single person; it's delivered by an integrated team of healthcare professionals working together to support your wellness journey. Each team member brings specialized expertise and collaborates seamlessly to ensure your care is comprehensive and consistent.

Learn more about our healthcare professionals

The Serefin Difference

With Serefin, you’re never navigating healthcare alone.

Book a meet and greet today to discuss how our team can simplify your care and support you every step of the way.

Get in touch

Luna, therapy dog, welcoming clients to Serefin Health Clinic

Member Services

In-House Specialists