Major components of the case manager and care coordinator
roles are described in Figures 2 and 3.
Effective use of both EMRs and regional information systems enabled high-performing ACOs to make local, data-driven decisions about which provider locations need embedded care coordinators
. For example, one of these ACOs relied on its system to determine which physician practices had the most concentrated ACO-panel, and it placed care coordinators
in those six high-volume primary care centers.
The RN care coordinator
talked with the nurse from the other facility, who provided the hospitalization history and explained Mr.
-How the embedded care coordinator
program will benefit from planned enhancements at YNHHS, including deployment of a clinically integrated network for community practices and an automated outreach platform to help close gaps in care.
An integrated team, to be in place by the end of the month, will include licensed behavioral health consultants, a medical social worker, a pharmacist, an RN case manager, a licensed practical nurse care coordinator
, a primary care provider, a psychiatrist, a patient access representative and a community health worker.
I start the conversation by explaining that a care coordinator
is a nurse or licensed social worker with additional training.
Without that, there's no way to pay for a nurse care coordinator
to follow up with discharged patients.
The Personal Care Coordinator
will understand the complexities of the modern health-care system and will also be familiar, on a granular level, with each client's unique health-care situation and history.
"The RCP is the one-stop shop," said Susan Roberts, deputy director care coordinator
for the Transition Policy and Care Coordination Office.
Today, the use of a software-assisted spine patient triage and registered nurse care coordinator
patient navigation system in this multidiscipline, multimodality comprehensive spine program provides quick and efficient patient triage to the appropriate level of spine care (surgeon vs.
Collymore moved north from Seattle, where he spent the last six years as Medical Director over Care Coordinator
at Group Health.
The program matches eligible children who are enrolled in the Pennsylvania's Children's Health Insurance Program (CHIP) through Highmark Blue Shield with a community-based care coordinator