RN Care Coordination & Transitions Leader

Yale New Haven Health; Fort Trumbull (CT); On-site; USD 85,000 - 110,000; Full time

Job summary

Yale New Haven Health seeks a CARE Center Nurse Advisor to coordinate complex patient referrals and transitions of care within the Yale Medicine CARE Center and Yale New Haven Health system.

The role requires a BSN or Associate degree in nursing, 3–5 years in acute or ambulatory care, and strong communication and organizational skills. You will collaborate with patients, families, physicians, and staff to ensure timely access to care.

Qualifications

• Excellent oral and written communication skills.
• Excellent assessment, communication, and organizational skills.
• Must be self motivated, goal oriented, and able to work independently.
• Ability to develop relationships and work collaboratively with patients, families, physicians, clinical staff, hospital departments, community, and outside organizations.

Responsibilities

• Supports and enhances scheduling patient appointments and referrals and assumes clinical nursing responsibilities for the Yale CARE Center.
• Acts as a clinical liaison between patients, families, referring providers, specialty teams, and community to ensure timely access to appointments.
• Monitors KPI metrics and participates in performance improvement activities related to transitions of care and patient access to care.
• Coordinates multiple appointments across provider visits, diagnostic testing, procedures, and ancillary services.
• Supports transitions of care by monitoring daily reports of Yale Medicine patients discharged from hospital or ED who may need follow-up care.

Skills

Communication

Organizational skills

Critical thinking

Relationship building

Independent work

Data management

Education

BSN or Associates degree in Nursing

Masters degree in Nursing or Healthcare preferred

Job description

Yale New Haven Health seeks a CARE Center Nurse Advisor to coordinate complex patient referrals and transitions of care within the Yale Medicine CARE Center and Yale New Haven Health system.

The role requires a BSN or Associate degree in nursing, 3–5 years in acute or ambulatory care, and strong communication and organizational skills. You will collaborate with patients, families, physicians, and staff to ensure timely access to care.