Care Coordination RN — Transitions & Access

Yale NewHaven Health; Milford (CT); On-site; USD 85,000 - 110,000; Full time

Job summary

Yale NewHaven Health CARE Center is seeking a Nurse Advisor to coordinate complex patient referrals and support transitions of care from hospital or ED settings. You will be integral to the Yale Medicine CARE Center team, ensuring timely referrals to specialty clinics and seamless access to care for patients and families.

The role requires 3–5 years of acute or ambulatory nursing experience, an RN license in Connecticut, and strong communication and data management skills to drive performance

Qualifications

• BSN or Associate's degree in Nursing required; Master’s degree in Nursing or Healthcare preferred.
• Three to five years of experience in acute or ambulatory care required; experience in clinical care for the specialty pod, process improvement, outcomes management, case management, and physician relations.
• Current State of Connecticut RN license.
• Background in disease-specific care and ability to work in a fast-paced academic medical environment; strong assessment, communication, and organizational skills.

Responsibilities

• Coordinate scheduling of patient appointments and referrals, serving as a clinical leader and patient advocate for the Yale CARE Center.
• Act as clinical liaison between patients, families, referring providers, and teams to ensure timely access to appointments.
• Monitor KPI metrics and participate in performance improvement activities related to transitions of care and patient access.
• Coordinate multiple provider specialty visits, tests, procedures, and sequencing of appointments to meet patient needs.
• Support transitions of care and follow-up for discharged Yale Medicine patients.

Skills

Clinical care

Process improvement

Outcomes management

Case management

Physician relations

Communication

Data management

Education

BSN or Associate's degree in Nursing

Master's degree in Nursing or Healthcare (preferred)

Tools

EHR systems

Job description

Yale NewHaven Health CARE Center is seeking a Nurse Advisor to coordinate complex patient referrals and support transitions of care from hospital or ED settings. You will be integral to the Yale Medicine CARE Center team, ensuring timely referrals to specialty clinics and seamless access to care for patients and families.

The role requires 3–5 years of acute or ambulatory nursing experience, an RN license in Connecticut, and strong communication and data management skills to drive performance