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Care Coordinator for High-Risk Patients

2 months ago

Stuart, Florida, United States Cleveland Clinic Full time
About the Role

Cleveland Clinic is seeking a highly skilled RN-HVTI Care Coordinator to join our team. As a Care Coordinator, you will play a critical role in ensuring the seamless coordination of care for high-risk patients.

Key Responsibilities
  • Identify patients with ongoing care coordination needs and outline the nature and duration of involvement required by the specialty care team.
  • Utilize assessment skills and risk assessment tools to identify patients with actual or potential care needs that would require care coordination.
  • Conduct targeted outreach to high-risk patients to ensure timely and efficient care delivery across the continuum of care.
  • Manage populations using technological tools and conduct comprehensive clinical assessments to identify disease-specific, age-specific, medical, behavioral, pharmacy, social, and end-of-life needs.
  • Work collaboratively with interdisciplinary teams to develop goals and plan interventions to maximize patient outcomes.
  • Monitor patient compliance with the plan of care and perform reassessments to update the plan as needed.
  • Ensure care gaps are closed around specialty disease, chronic disease, or surgical episodes.
  • Serve as the primary patient contact for the team and facilitate access to services.
  • Coordinate members of the patient care team and serve as a liaison between patients, families, and physicians.
  • Assist in managing transitions of care across care settings and identify barriers to receiving care.
Requirements
  • Graduate from an accredited school of professional nursing.
  • Current state licensure as a Registered Nurse (RN).
  • Three to five years of nursing experience.
What We Offer

Cleveland Clinic is a world-renowned healthcare organization that values its caregivers. We offer a supportive work environment, opportunities for growth and development, and comprehensive benefits that invest in your health, well-being, and future.