Care Coordinator

Care Coordinator

The Care Coordinator plays a crucial role in the Hospital Admission Risk Program, Post Acute Care and Sub-Acute Ambulatory Care Services focusing on the management of chronic conditions and complex care needs. 

The Care Coordinator works with people who:

• have chronic health conditions and/or complex healthcare needs
• are experiencing multiple factors - social, environmental, financial and cultural - impacting on their health
• frequently use hospitals or are at risk of hospitalisation
• who would benefit from care coordination and self-management support.

The Care Coordinator must have good knowledge in primary health care services and the ability to provide integrated client-centred care for our consumers with chronic and complex conditions.

Responsibilities include:

- Assisting in achieving consistency of care between acute and community-based services. This involves clear communication, linkages, and collaborative integrated care planning; 

- Providing a holistic assessment of clients, care coordination, and self-management coaching support to help clients achieve self-management and lifestyle goals; 

-Monitoring client progress and evaluating care plans in liaison with GP’s and the multidisciplinary team at all stages of client care provision; 

- Ensuring clear communication between services, preventing duplication of referrals and service delivery; and 

- Undertaking advocacy roles where necessary, especially where there is a carer identified.