Clinical CARE Coordinator: Ambulatory Care Services; Sickle Cell Disease Clinical Care Coordinator

Michigan Medicine improves the health of patients, populations and communities through excellence in education, patient care, community service, research and technology development, and through leadership activities in Michigan, nationally and internationally. Our mission is guided by our Strategic Principles and has three critical components; patient care, education and research that together enhance our contribution to society.

• Coordinate care transitions between inpatient, outpatient, and emergency department settings, including post-discharge outreach to identify unmet needs, address barriers, and triage ongoing symptoms.
• Facilitate timely outpatient follow-up after hospital or emergency department encounters and support medication continuity at discharge.
• Monitor patterns of infusion center use and arrange outpatient follow up if frequent
• Serve as the primary adult-clinic point of contact for patients transitioning from pediatric to adult sickle cell care; support early engagement with the adult care team.
• Recognize psychosocial barriers to care and connect patients with social work services to facilitate transportation, insurance enrollment, and connection to mental health and/or community resources.
• Support development and use of standardized workflows, checklists, and documentation templates for care coordination activities.
• Monitor and help maintain individualized pain management plans in collaboration with the clinical and pharmacy team.
• Review key quality indicators (e.g., outpatient engagement, adherence to disease-modifying and preventive screening) and collaborate with the care team to address identified gaps.
• Demonstrate critical thinking skills using the nursing process, excellent problem-solving skills, and demonstrated ability to set priorities.
• Demonstrate customer service, interpersonal communication skills, and the ability to build respectful relationships within and between units and individuals.
• Demonstrate accountability and dependability, including a good attendance record with punctuality.
• Demonstrate adaptability to changing needs and priorities based on unit, department, and institutional goals/objectives.
• Demonstrate knowledge and skills providing patient and family education and reinforcement related to oncologic conditions including, but not limited to, chemotherapy, immunotherapy, oral therapy, infusion, etc.
• Proficiency with typing and electronic health record documentation.
• Ability to manage complex clinical issues utilizing assessment skills, protocols, and evidence-based interventions.
• Willingness to adapt to different populations within the team as patients? demands require. Orientation and training would be provided for new subspecialties.

• Current licensure as a Registered Nurse in the State of Michigan.
• Bachelors of Science in Nursing
• Minimum of 18 months Adult Sickle Cell Ambulatory Care Experience
• Minimum of 18 months Adult Benign Hematology Ambulatory Care experience within the last two years
• Minimum of five (5) years of Oncology RN experience within the last six (6) years

NOTE:

In order to be considered for this position the applicant must have met or will have met all the required qualifications prior to the start date of employment.

• Experience in care coordination, case management, chronic disease management, or a related clinical care setting for the hematology/oncology patient population within the last 2 years.
• Experience with patients undergoing sickle cell treatment in the last 2 years.
• Experience as a Nurse Navigator or Clinical Care Coordinator in the last 5 years.
• Ambulatory Care Experience…