What is a care coordinator?

By: The Capella University Editorial Team with Dr. Pelumi Hassan, DNP, RN, CCM, Assistant Professor, MSN Program

Reading Time: 3 minutes

A patient may leave an appointment with referrals, test orders and follow-up instructions, yet still be unsure about what happens next. And communication between different clinics and settings can often be a challenge.

That’s where care coordinators come into play: these healthcare professionals help patients navigate a complex healthcare system by organizing services, communicating among providers and ensuring the patient receives the right care at the right time. Their primary goal is to improve patient outcomes, reduce gaps in care and support patients throughout their care journey.

Helping patients on their care journey

A care coordinator acts as a primary point of contact for patients through all aspects of their treatment. Depending on the setting, this work may include:

• Helping schedule follow-up appointments
• Explaining next steps in a treatment plan
• Answering questions as care progresses
• Communicating with clinicians across departments
• Supporting transitions from clinical settings to home
• Arranging transportation for medical care

For many patients and families, the coordinator becomes a consistent clinical point of contact. This support is especially important during care transitions.

“Without a care coordinator, patients leaving the hospital with a new diagnosis or complex conditions like heart failure or diabetes face dangerous gaps in their care,” explains Dr. Pelumi Hassan, an assistant professor in Capella’s MSN program. “A patient might receive new prescriptions that interact with their current medications, and without expert guidance, this can lead to serious medical errors.”

Dr. Hassan notes that this work helps prevent medical errors, reduce avoidable readmissions and support safer transitions between settings. Care coordinators conduct medication reconciliation, coordinate follow-up appointments and order necessary medical equipment, among many other basic but essential tasks.

“By acting as a link between the patient and the care team, care coordinators can anticipate problems before they occur and help reduce preventable readmissions,” Hassan says.

The importance of managing patient needs across care settings

Managing patient needs across care settings helps ensure the right care happens at the right time and in the right place. When communication breaks down, gaps, duplication and confusion can follow.

Electronic health records, patient portals and population health tools can help identify gaps and support timely follow-up.

Larger changes in healthcare delivery are also shaping how this work is defined. “Healthcare is shifting away from just treating sickness and moving toward keeping whole communities healthy through values-based care,” says Dr. Hassan. “Nurses now need to be tech-savvy, using data and telehealth to monitor patients from their own homes rather than just in the hospital.”

She also points to the growing impact of social determinants of health that affect recovery, such as housing and food access. “Care coordinators must be skilled at connecting patients with community resources and working across different cultures to ensure everyone gets fair and effective care,” adds Dr. Hassan

Preparing for systems-focused nursing roles

For nurses, managing care across settings offers a different way to impact patient outcomes.

Explore Capella’s MSN in Care Coordination to prepare for nursing opportunities that support continuity across the care continuum.