Care Plan Nurse

The Care Coordinator is to coordinate team-based care to provide health services to individuals, through effective partnerships with patients, their caregivers/families, community resources, and their physician. Facilitates a “shared goal model” within and across settings to achieve coordinated high-quality care that is patient and family centered.

Essential Functions

• Promote the mission, vision, and values of the organization
• Recognizes and responds to opportunities for improvement.
• Provides mentoring/coaching of other population health and care coordination team members and coach patients/families toward successful self-management of their chronic disease.
• Utilize tools and documents that support a guided care process, collaborate with patients/family toward an effective plan of care
  
  
  

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