Clinical Care Coordinator

• Coordinate patient care across outpatient, ambulatory, freestanding emergency department, post-acute, and community-based settings
• Collaborate with patients, families, physicians, advanced practice providers, care teams, and community resources to facilitate safe transitions and timely follow-up
• Identify patients at increased risk for hospitalization, readmission, emergency department utilization, poor health outcomes, or unmet social needs
• Develop and implement individualized care plans addressing clinical, psychosocial, and resource needs
• Assess social determinants of health and connect patients with internal and external resources
• Communicate with interdisciplinary teams regarding patient needs, care plans, transitions, and significant clinical events
• Evaluate patient problems, care provided, and patient responses to meet patient and family needs
• Review daily inpatient discharge reports and prioritize post-discharge needs, abnormal laboratory findings, pending diagnostic results, follow-up scheduling, and high-risk readmission coordination
• Coordinate interventions to reduce avoidable readmissions and emergency department utilization
• Support Baptist freestanding emergency departments with patient navigation, community referrals, follow-up arrangements, chronic disease management, and disposition planning
• Maintain accurate and timely documentation in accordance with organizational policies, regulatory requirements, and professional standards

RN – Clinical Care Coordinator

• Collaborate with a multidisciplinary team to provide comprehensive care to adult patients with sickle cell disease
• Establish goals and strategies to meet patients' continuing needs
• Coordinate care and follow up on care plans, focusing on symptom management
• Build trusting relationships and advocate for patients and families
• Help patients overcome barriers to care and connect with resources
• Support program development through data collection, quality improvement, and outcomes evaluation
• Incorporate evidence-based practices and emerging advances into patient care
• Participate in community outreach and education to expand access and reduce stigma

Clinical Care Coordinator jobs in United States

RN – Clinical Care Coordinator

RN Clinical Program Coordinator – Sickle Cell Care