✅ Reviewed for accuracy and relevance by Deanna Cooper Gillingham, RN, CCM, FCM on June 26, 2025.
Care coordination involves deliberately planning and organizing a patient’s care between two or more people, including the patient. Coordination is “the process of organizing, securing, integrating, and modifying the resources necessary to accomplish the goals set forth in the case management plan” (CCMC Glossary of Terms, 2022). Since the healthcare continuum comprises resources and services of varying complexity and intensity, a key principle of care coordination is matching the patient’s needs with the appropriate level of care. A CM’s role is to ensure patients receive care at the least intensive and restrictive level that is safe and effective. Case managers work to transition clients to lower (less intensive) levels of care as their medical conditions improve. If a patient’s condition worsens, the case manager facilitates transition to a higher level of care.
Throughout the continuum, the CM promotes the patient’s well-being, autonomy, and self-determination. They advocate for the client to secure the right care in the right place at the right time. This requires ongoing assessment of the patient’s clinical and psychosocial needs, as well as their readiness for transitions.
Effective care coordination depends on communication and collaboration among the various service providers and support persons involved in the patient’s care. The case manager is often the hub who facilitates the exchange of information and coordinates services as the patient moves through the continuum. This role is essential for avoiding gaps, duplications, and conflicting plans of care.
This article shares a portion of the information covered on this topic in CCM Certification Made Easy, 4th Edition by Deanna Cooper Gillingham, RN, CCM, FCM (2025). For more details on this topic and related concepts, purchase your copy at CCMCertificationMadeEasy.com.
