Clinical Care Coordinator

2 weeks ago

Towson MD, United States Greater Baltimore Medical Center Full time
Clinical Care Coordinator - Greater Baltimore Medical Center

The Clinical Care Coordinator is dedicated to delivering high-quality care management and the seamless coordination of clinical activities for patients in primary care settings.

This role emphasizes the importance of early intervention for patients with complex health needs and involves co-developing care plans that aim to prevent complications and enhance patient outcomes.

The Clinical Care Coordinator plays a vital role in managing populations by providing effective education, supporting self-management, setting achievable goals, and ensuring timely access to healthcare services.

This position entails ongoing communication with patients and their families regarding their care progress and needs, as well as developing and overseeing care management processes while supporting the primary clinical team.

The Clinical Care Coordinator fosters collaborative relationships with all team members, including the Practice Manager, Lead Physician, Care Coordinator, and Behavioral Health Care Manager, to effectively address the needs of the designated patient panel and primary care teams.

The Clinical Care Coordinator will also serve as a clinical resource for Medical Assistant staff and the Practice Manager.

Qualifications:
Registered Nurse license is mandatory. A Bachelor's degree in Nursing is preferred.

Experience:


This position requires a comprehensive understanding of disease management, including diagnostics, treatment options, prognosis, community resources, and care levels throughout the healthcare continuum.

1-2 years of clinical experience is preferred but not essential.

Relevant experience in one or more of the following healthcare areas is preferred:

  • Coordination of community resources
  • Management of diverse patient populations
  • Familiarity with care in outpatient settings
Working knowledge of Care Management models, particularly in the State of Maryland.

Skills:

  • Proficient in clinical assessment, patient interviewing, and education
  • Engages in data collection, analysis, and reporting to evaluate program effectiveness and identify areas for improvement.
  • Strong oral and written communication skills to address interdepartmental concerns, resolve issues, and manage conflicts.
  • Demonstrated problem-solving abilities using available resources creatively.
  • Competent in computer and productivity tools to enhance job performance.
  • Maintains up-to-date knowledge of professional standards through continuing education and active participation in community and professional activities.
  • Exhibits a compassionate and empathetic approach with a proactive attitude.

Key Responsibilities:
Care Management

  • Evaluates patients within a defined caseload to identify clinical needs, financial resources, and care objectives. Continues to assess patient management needs through regular communication with the care team, patients, and families.
  • Actively manages a panel of chronic care patients (high acuity/complex) by establishing relationships with patients as integral team members and providing follow-up to ensure adherence to care recommendations.
  • Implements standing orders for necessary tests and preventive services.
  • Oversees various aspects of patient care, including referrals to specialists, hospital admissions, emergency visits, and ancillary testing. Responsible for providing telephone advice as per protocol and addressing urgent and emergent calls.
  • Prioritizes care management activities based on patient and system needs to achieve optimal quality and cost outcomes.
  • Collaborates with patients, providers, care coordinators, behavioral health care managers, families, and other healthcare team members to facilitate transitions in care.
  • Develops and executes plans for assessment, education, goal setting, and tracking outcomes.
  • Participates in meetings to report on care transformation metrics and quality outcomes.
  • Engages in practice strategy discussions for performance improvement and innovation.
  • Works with clinical teams as a resource for managing assigned patients, ensuring pre-visit planning, and enhancing patient engagement in health improvement activities.
  • Collaborates with the MIS team to facilitate registry reporting and documentation of evidence-based guidelines.
  • Acts as a resource for clinical staff and providers in establishing quality goals based on reports.
  • Coordinates with patients and their care teams to assess readiness for change, conduct needs assessments, and develop individualized care plans.
  • Works with patients and care team members to monitor progress toward health goals and address barriers to treatment adherence.
  • Oversees the development and implementation of patient self-management educational resources used by primary clinical teams.
  • Collaborates with payer case managers for additional services when necessary.
  • Builds and maintains relationships with frequently utilized entities.
  • Coordinates efficient communication for consult requests and consistent documentation of patient self-management measures.

Core Values:
Respect

I will treat everyone with courtesy and foster a healing environment.

  • Treats others with fairness, kindness, and respect for personal dignity and privacy.
  • Listens and responds appropriately to others' needs and feelings.
Excellence

I will strive for superior performance in every aspect of my work.

  • Meets and exceeds customer expectations.
  • Actively pursues learning and self-development.
  • Pays attention to detail and follows through.
Accountability

I will act professionally and take ownership of problem-solving.

  • Sets a positive example for others.
  • Takes ownership of challenges and resolves them effectively.
  • Plans and utilizes resources appropriately.
  • Reports to work regularly and punctually.
Teamwork

I will engage collaboratively and keep others informed.

  • Works cooperatively with others for team success.
  • Addresses and resolves conflicts positively.
  • Seeks out others' ideas to reach optimal solutions.
  • Acknowledges and celebrates contributions from team members.
Ethical Behavior

I will act with honesty and integrity.

  • Demonstrates honesty, integrity, and good judgment.
  • Respects the cultural, psychosocial, and spiritual needs of patients and colleagues.
Results

I will set goals and measure outcomes that align with organizational objectives.

  • Embraces change and improvement in the workplace.
  • Continuously seeks to enhance the quality of services.
  • Displays flexibility in addressing new challenges.
  • Achieves results on time by focusing on priorities.
COVID-19 Vaccination


All applicants must be fully vaccinated against Covid-19 or obtain an approved medical or religious exemption prior to employment.

Equal Employment Opportunity

Greater Baltimore Medical Center and its affiliates are Equal Opportunity employers.

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, age, national origin, disability, genetic information, veteran status, or any other status protected by law.

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