RN Care Coordinator - Center of Brain Health

As a Care Coordinator, you will work collaboratively with multidisciplinary care team staff across the continuum of care for high-risk patients. In this role, you will provide coordination of care and disease management longitudinally for patients with chronic conditions or episodic care for a surgical population. You will focus on patient outreach and care coordination for a panel of patients to achieve optimal outcomes and promote wellness, helping to decrease preventable emergency department visits and readmissions while improving patient satisfaction.

A caregiver in this position works full-time|40 hours| 8:00am-5:00pm| no weekends, holidays, on-call| Hybrid 3 days per week after orientation (90days).

A caregiver who excels in this role will:

• Work collaboratively with a multidisciplinary care team across the continuum of care for high-risk patients to develop goals, plan interventions and maximize patient outcomes.

• Provide care and disease management coordination.

• Identify patients in the specialty care practice that have ongoing coordination needs and conduct targeted outreach.

• Conduct comprehensive clinical assessments that include disease/age-specific, medical, behavioral, pharmacy, social and end of life needs of each patient.

• Inform and work with patients and their families regarding coordination of their care, provide education and coaching, monitor patient compliance with their care plan, perform reassessments regarding patient progress toward goals, and update plan of care.

• Serve as a liaison and advocate for patients and families.

• Assist in managing transitions of care across care settings, ensuring optimal communication and planning.

• Identify barriers, facilitate solutions, and connect others to community resources.

Minimum qualifications for the ideal future caregiver include:

• Graduate from an accredited school of Professional Nursing

• Current state licensure as a Registered Nurse (RN)

• Basic Life Support (BLS) Certification through the American Heart Association (AHA) or American Red Cross

• Three to five years of nursing experience

• Any registered nurse or advanced practice nurse must obtain a cancer specific certification or demonstrate ongoing qualifying education within the timeframe of the facilities accreditation cycle, if they work in medical oncology, radiation oncology, cancer center or cancer clinic and/or administer chemotherapy within an accredited Cleveland Clinic facility

Preferred qualifications for the ideal future caregiver include:

• Bachelor’s of Science in Nursing (BSN)