RN Care Coordinator (CCP)


Licensed Register Nurse Care Coordinator will provide short term care coordination services to individuals and families.  The Registered Nurse Care Coordinator will be responsible for assessing, coordinating services, and partnering with community resources to address the needs of an assigned population.  To provide support and expertise through assessment, planning, implementation and overall evaluation of the individual client needs.


–          Function as Co-Team Leader to assess individual client cases for appropriate assignment to CCP staff (i.e. RNCC, SWCC, Ombudsmen and CCA)

–          Co-facilitate team meetings to allow for discussion of best practices, consultation on difficult cases, sharing resources, etc.

–          Knowledge of: theories, principles, and effective techniques deployed by registered nurse.  Individual and group dynamics.

–          Skills in: Establishing and maintaining effective working relationships with clients, associates, staff of MCOs, and other community groups/programs who may be involved with the client or family.  Working with various populations and culturally diverse groups. Preparation of accurate and comprehensive reports. Written and oral communication.

–          Adhere to departmental goals, objectives, standards of performance, and policies and procedures.


  2. Work with Co-Team Leader to assess program referrals to determine appropriate assignment to CCP staff.
  3. Co-facilitate weekly team meetings to provide consultation for medically complex cases, general case discussion for sharing of best practices and resources.
  4. Develop and facilitate services that provide education, screening and advanced assessments for the assigned population.
  5. Provide education, assistance and care coordination services to high-risk pregnant women and infants, referred clients that have experienced an infant or child loss, as well as clients with complex medical and/or psychosocial needs.
  6. Assess prenatal clients’ risk and eligibility for referral to Baltimore City’s network of home visiting programs according to established vulnerability index criteria/guidelines.
  7. Provide appropriate resource linkage to programs and services such as WIC, MCO case management, safe sleep, car seat assistance, etc., that assist pregnant/postpartum women and families in Baltimore City.
  8. Consult with other community agencies to identify potential resources for resolving client’s health, psychosocial or financial problems.
  9. Deploy various methods for locating referred clients that are difficult to locate; establishing liaisons with DSS, PCP’s, neighbors, churches, and other community groups.
  10. Develop and implement methods for coordinating and evaluating nursing care coordination services that are carried out in diverse settings such as client homes, public agencies, churches, community-based organizations, etc.
  11. Effectively interview clients so a realistic assessment of their needs can be determined and an individual service plan developed with in-put from the client, referring MCO, and case management team members.
  12. Function as a liaison to external agencies and shares information with others, which may impact care and/or services of clients and referral services.
  13. Participates in staff, community, professional and inter-agency meetings and conferences.
  14. Documents clientassessments, activity, treatment plans and resolutions; prepares narrative and statistical reports.
  15. Perform other appropriate duties as assigned.


Minimum Qualifications

  • A Bachelor’s degree in nursing from an accredited college or university.
  • Current licensure as a Registered Nurse in the State of Maryland.
  • A minimum of one year related experience
  • Relevant clinical experience providing services to pregnant women and/or infants, preferably in a public health/community setting.
  • Good planning and organizational skills
  • Well developed interpersonal & communication skills
  • Professional appearance and demeanor
  • Computer literate specifically MS Word, Excel, Access, and Outlook.

Physical Requirements:

The ideal candidate must be able to:

  • Ambulate 3 blocks or more
  • Key data
  • Sit for extended periods
  • Lift at least 15 lbs.

Interested candidates should apply by visiting: https://home.eease.adp.com/recruit/?id=1047141