ITC Clinical Care Coordinator

Job Description

The Integrated Team Care (ITC) program aims to improve access to the most appropriate health services for Aboriginal and Torres Strait Islander people with chronic conditions and complex care needs at the right time, and in the right place, with a view to reducing avoidable acute hospital admissions or readmissions, and emergency department presentations; improved use of the healthcare system and to support people to take part in a healthy lifestyle and become self health literate to self manage these conditions.


To provide a range of primary and secondary intervention services that contribute to improving overall health outcomes of Aboriginal & Torres Strait Islander people with chronic and complex care needs in the Gladstone region.

This will be achieved by:

  • Proactive management of the client cycle of care in line with Model of Care and GP Management Plans, and working as part  of the multidisciplinary team at GRAICCHS, to deliver the ITC program
  • Increase the uptake of Aboriginal and Torres Strait Islander specific Medicare Benefits Schedule (MBS) items, including Health Assessments, diabetes cycles of care, home medication reviews, chronic and mental health management plans and follow up items
  • Liaison with local Indigenous communities /groups identifying barriers and improving access
  • Assessment of referrals, access, data reporting, planning supplementary services and support of visiting specialist and allied health services ensuring clinics are well accessed.
  • Improve access and capacity for delivery of culturally appropriate primary care services by general practice, allied health and specialists for Aboriginal and Torres Strait Islander people
  • Within the ITC program footprint work collaboratively with mainstream general practitioners, to facilitate  appropriate multidisciplinary care for Aboriginal and/or Torres Strait Islander people with target chronic diseases
  • Support of Aboriginal and Torres Strait Islander people with self-management and access to appropriate health care through care coordination and provision of supplementary services for chronic disease

  • Certificate IV or higher qualifications in Health field
  • Professional registration with AHPRA
  • Experience and knowledge of working in the Primary Health Care setting.
  • Ability to foster and maintain effective networks, alliances and relationships with other health sector professionals and organisations
  • Experience in developing and maintaining effective networks, alliances and relationships with other health sector professionals and organisations
  • An ability to consult with health professionals, practice managers and others about client/patient care issues and translate this into coherent plans of service delivery
  • Demonstrated administration, coordination, planning, reporting performance and evaluation skills
  • Working knowledge of health issues affecting Aboriginal and Torres Strait Islander people and a strong commitment to improving health outcomes
  • An ability to communicate sensitively and effectively with Aboriginal and Torres Strait Islander people.
  • Satisfactory Police Check – no Serious/Criminal/Court Record
  • Current Blue Card (working with children and young people) or willingness to apply for a Blue Card, unless AHPRA registered.
  • Current CPR and First Aid Certificate
  • Current Class c Drivers Licence (Qld)