Outpatient Care Coordinator RN

Hchcares; New Castle (IN); On-site; USD 55,000 - 75,000; Full time

Benefits offered by this job

Continuing education scholarships

Generous paid days off

Employer funded pension

Job summary

The RN Care Coordinator at Hchcares will collaborate with providers, moderate-high risk patients, and the primary care team to assess change readiness and develop patient-centered care plans for chronic conditions measured by clinical indicators.

You will guide patients through the health care system, coordinating across settings to achieve coordinated, high-quality, patient-centered care and to cultivate relationships with health care providers through a shared goal model.

Qualifications

• Current Indiana RN licensure required.
• BSN and 2+ years of experience preferred.
• CCM certification preferred.

Responsibilities

• Involve high risk individuals in activities to improve health and partner with care team to set goals and steps.
• Provide a coordinated strategic approach to detect early and manage chronic disease.
• Coach patients/families toward self-management of chronic conditions.
• Create/update personalized care plans for patients.
• Facilitate access to medical and specialty providers and support staff.
• Support co-management with communication and referrals across settings.
• Serve as contact point for patient, family, care team, payers and community resources; track tests, meds, adherence.
• Link patients to social services and transportation/interpretation services.
• Conduct regular follow-ups to evaluate progress and health outcomes.

Skills

Communication skills

Leadership

Counseling

Organizational skills

Travel locally

Education

BSN

Indiana RN licensure

CCM (certified case manager)

Job description

Overview

The RN Care Coordinator will collaborate with providers, moderate-high risk patients and the primary care team to assess change readiness and develop a patient-centered care plan supported by management of chronic conditions measured by clinical indicators. RN Care Coordinators ensure all health care providers involved are up to date with case information re:their population and help guide patients through the health care system and cultivate relationships with health care providers by facilitating a shared goal model within and across settings to achieve coordinated high quality care that is patient centered.

Responsibilities

• Involve high risk individuals in activities to improve their health and partner with their care team to establish goals and action steps that focus on wellness and self-management of chronic conditions
• Provide a coordinated strategic approach to detect early and manage effectively the patient with chronic disease.
• Coach patients/families toward successful self-management of their chronic conditions
• Create/update personalized care plans for patients.
• Facilitate patient access to appropriate medical and specialty providers as well as other care coordination team support specialist (e.g.Diabetes Educator).
• Cultivate and support primary care and sub-specialty co-management with communication, inquiry, follow-up, and integration of information into the care plan regarding transitions-in-care and referrals.
• Serve as the contact point, advocate, and informational resource for patient, family, care team, payers, and community resources. Ensure effective tracking of test results, medication management, and adherence to follow-up appointments.
• Linking patients to social services programs and entitlements such as transportation assistance and interpretation services.
• Conducting regular follow-ups with patients to evaluate progress, promote continuity of care and ensure improved health outcomes.

Qualifications

• Current lndiana RN licensure required.
• Previous experience in caring for chronic disease patients.
• BSN and 2+ years of experience preferred.
• CCM (certified case manager) preffered.
• Demonstrates evidence of essential leadership, communication, education, collaboration and counseling skills.
• Outstanding communication skills, both written and verbal.
• Excellent organizational skills
• Ability to travel locally.
• Knowledge and sensitivity to communication strategies, accessibility and ability to identify appropriate communication strategies when required

The above statements are intended to describe the functions and related requirements of persons assigned to this job. They are not intended as an exhaustive list.

Benefits

We believe that work-life balance is critical to fulfilling our values of excellence and service. That’s why we offer flexible scheduling, competitive compensation, bonuses and discounts for you and your family. In addition to health, vision and dental insurance; a few of the benefits available at HCH include:

• Continuing education scholarships
• Generous paid days off (PDO) - with the option to rollover unused hours each year
• Employer funded pension