Registered Nurse - Unit Clinical Care Coordinator

Unit Clinical Care Coordinator

The Unit Clinical Care Coordinator serves as the primary liaison among emergency services, surgical services, nursing, finance, physicians, utilization review, and medical records to ensure appropriate bed assignments, patient care needs are met, and treatment plans are executed at the correct level of care. This role requires exceptional organizational skills to manage multiple tasks simultaneously and the ability to respond effectively in crisis situations, quickly assimilating information to make sound decisions and recognizing circumstances that demand immediate intervention.

The coordinator maintains up-to-date knowledge of healthcare economics, trends, and reimbursement methodologies, applying this expertise to daily practice while continuing professional development to deliver care tailored to each patient. Additionally, the Unit Clinical Care Coordinator oversees patient progression and length of stay for the unit’s patients through collaboration and partnership with all members of the healthcare team.

• Partner with PLC and other care coordination roles to facilitate patient progression of care.
• Provide PLC with timely visibility to potential unit transfers and discharges.
• Ensure Care Logistics software accurately reflects unit and patient status, including transfers, discharges, and patient location.
• Review physician admission orders and validate status and level of care; manage observation hours and inpatient target LOS.
• Evaluate discharge needs upon admission and ensure a complete discharge plan; refer complex cases to appropriate roles.
• Collaborate with unit staff and support teams to progress patient care toward discharge and expedite unit flow for admissions, transfers, and discharges.
• Adjust unit staffing needs based on census and callouts in coordination with Care Management leadership.
• Complete required care management functions and documentation, including discharge planning assessments and coordination of simple discharges such as home health, DME, or dialysis.
• Oversee completion of pre‑procedural requirements and communicate readiness or barriers to the Order Organizer.
• Identify opportunities to transition testing to outpatient settings and escalates as appropriate.
• Maintain daily communication with physicians through SNAP huddles or Epic to address progression and discharge barriers.
• Manage and update Care Advance in real time.
• Identify patients at risk for readmission and communicate findings to the care team; verify completion of readmission assessments.
• Lead SNAP huddles to anticipate and resolve barriers to progression or discharge; escalates unresolved issues to unit leadership.
• Review expected discharge dates, target LOS, and working DRG daily; collaborate with CDI team for DRG updates and documentation queries.
• Assign and resolve discharge needs and barriers with nursing and care team roles; initiate interventions as needed.
• Monitor patients in observation or outpatient status and update status appropriately.
• Coordinate sequencing of care and interventions with physicians and nurses; ensure appropriate order sets and protocols are initiated.
• Collaborate with PLC, ED, surgical teams, providers, and other disciplines on patient progression and care coordination.
• Work with PLC Program Assistant for transportation and other care arrangements.
• Communicate discharge goals and plans with patients and families in collaboration with providers and care team; address concerns and arrange family meetings as needed.
• Update patient status and planned discharge times in Care Logistics software and EMR.
• Collaborate with Utilization Review nurses on status changes and deliver regulatory letters when required.
• Ensure payer and status requirements align with clinical progression in collaboration with UR nurses.
• Serve as consultant and educator for medical staff regarding patient status, placement, payer requirements, and resource utilization.
• Proactively identify and remove barriers to patient flow at the unit and system level.
• Meet deadlines and exceed facility and unit metrics through adherence to policies and standard operating procedures.

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