Care Coordinator RN – Grace Medical Center
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Job Summary
The RN Community Care Coordinator manages individualized patient-centered goal-directed nursing care through use of the nursing process and the principles of primary nursing, in accordance with departmental and hospital policies and procedures. Provides care coordination/management for patient populations, including but not limited to MDPCP identified patients, with the ultimate goal of improved health, reduced health care costs, and better coordination of care. The RN Care Coordinator accepts care management referrals, maintains an assigned caseload (50‑75), and utilizes evidence-based medicine, data analytics, and innovation in implementing care management principles. The RN Care Coordinator works with the primary care interdisciplinary team (IDT) to coordinate care to obtain desired health outcomes, improve self‑care abilities, decrease cost of care, and provide extraordinary patient care.
Responsibilities
Assess and develop comprehensive care plans for assigned patients.
Coordinate referrals and transitions of care across providers and settings.
Perform medication reconciliation and monitor adherence.
Provide outreach and health promotion services.
Educate patients, families, and caregivers.
Evaluate effectiveness of care plans and report to IDT.
Manage high‑risk, high‑cost patients and support chronic disease management.
Facilitate timely access to appointments and services.
Qualifications
Graduate of an accredited school of nursing; Bachelor’s Degree (BSN) required, Master's preferred.
Current valid RN license in Maryland or applicable Compact State.
3–5 years of acute‑care nursing experience; care‑management experience a plus.
Case/care management certification or knowledge of national care‑management standards preferred.
Strong verbal, communication, organizational, analytical, data management, and computer skills.
Proficiency in electronic medical records desirable.
Previous ambulatory and population health experience helpful.
Additional Information
Who We Are – LifeBridge Health is a dynamic, purpose-driven health system redefining care delivery across the mid‑Atlantic and beyond, anchored by our mission to “improve the health of people in the communities we serve”.
What We Offer – Impact, Growth, Support, and Benefits, including competitive compensation, health plans, free parking, and wellness programs.
Why LifeBridge Health? – With over 14,000 employees and 130 care locations, we combine strategic growth, innovation, and deep community commitment to deliver exceptional care anchored by five leading centers in the Baltimore region.
LifeBridge Health complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, or gender identity/expression.