Care Coordinator - Concierge Medicine

Cleveland Clinic
1dOnsite

About The Position

At Cleveland Clinic Lou Ruvo Center for Brain Health, our caregivers are dedicated to helping patients cope with and manage the effects of memory loss. Come join us in our efforts to provide effective, evidence-based treatment with the latest technologies and approaches. Here, you will make a difference in the community, gain unmatched hands-on experience, enhance your skills and build a rewarding, life-long career at one of the most respected healthcare organizations in the world. The Concierge Medicine Department focuses on a delivering a higher level of care, detailed examinations and advanced assessments, offering a unique opportunity to develop meaningful, lasting relationships with both patients and providers. As a Care Coordinator on our team, you will work collaboratively with multidisciplinary care teams across the continuum of care for high-risk patients. You will provide longitudinal care coordination and disease management for patients with chronic conditions or episodic needs within a surgical population. This role focuses on patient outreach and ongoing coordination of care for a defined patient panel, supporting optimal outcomes and wellness while reducing preventable emergency department visits and readmissions and improving overall patient satisfaction. A caregiver in this position works Monday through Friday from 7:30 a.m. – 4:00 p.m. or 8:30 a.m. – 5:00 p.m.

Requirements

  • 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 the American Red Cross
  • Three to five years of nursing experience

Nice To Haves

  • Bachelor’s of Science in Nursing (BSN)
  • Specialty certification

Responsibilities

  • 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-specific, 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.
  • Work with provider teams to answer questions from patients.
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