RN CARE COORDINATOR

Christ Community Health Services; Memphis (TN); On-site; USD 65,000 - 90,000; Full time

Job summary

Christ Community Health Services in Memphis, TN seeks an RN Care Coordinator to join the Medical Home Care Team. The role coordinates patient care, navigates systems to improve health, and provides clinical supervision to assigned staff.

Responsibilities include coordinating scheduling and referrals, reviewing records, developing proactive care plans, supporting disease-specific self-management and medication adherence, and documenting in the EHR. Active RN license and BLS required.

Qualifications

• Two years of health-related care supervisory experience is preferred, but not required.
• Active RN licensure and valid BLS Certification.

Responsibilities

• Coordinate the care of patients as part of the PCMH Care Team.
• Navigate patients through systems to improve health and outcomes.
• Provide clinical supervision to assigned clinical team members.
• Review medical records to ensure completeness prior to patient exams.
• Coordinate scheduling and referrals for treatments, home health services, and hospital admissions.
• Document data and interactions in the electronic medical record (EMR).
• Instruct patients and families on health education and disease prevention.

Skills

Care coordination

Nursing

Patient education

Communication

Education

RN license

BLS certification

Tools

EMR systems

Job description

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RN CARE COORDINATOR

Full Time Admin, Memphis, TN, US

12 days ago Requisition ID: 1833

Position Summary

The Care Coordinator Nurse (RN) serves as an essential addition to the Medical Home Care Team by coordinating the care of patients, navigating patients through systems to improve health, and providing clinical supervision to assigned clinical team members.

Key Responsibilities

• Participate as a valued member of the PCMH Care Team to oversee the coordination of patients and PCMH as a whole.
• Use stratification tool to identify patients appropriate for care coordination.
• Prepare handoff tool that identifies patient gaps that need to be closed.
• Review medical records to ensure completeness prior to patient exam, obtaining missing documentation, lab reports, and consultation results. Documents clinic visits, observations, and related activities. Prepares and maintains required reports, records and files.
• Coordinate the scheduling and referral of patients for specific treatments, procedures, home health services, and hospital admissions.
• Track referral reports
• Conduct holistic assessments during patient visits to assess the needs and goals of patients and also alert other care team members about patient needs.
• Develop and maintain individualized and proactive care plans for care coordination population.
• Works with care team to focus on disease-specific self-management and medication adherence, while providing support, information and education for specific diseases.
• Provide communication and support to the providers on all assigned cases.
• Navigate patients through systems and across transitions.
• Contact patients appearing on registries and in need of treatment and/or follow-up
• Document data and interactions with patients in electronic medical records
• Instruct individuals, families, or other members of the patient’s care team on health education, disease prevention, or community resources.
• Collaborate with other care team members to proactively perform care coordination for patients that are enrolled in care coordination.
• Communicate patient concerns that need to be addressed during Huddle with Team Nurse
• Assist with the completion of tasks assigned to the care team from the EHR such as prescription refills or communication of lab results.
• Responds to patient telephone calls
• Assist care management patients with achieving set goals by implementing relevant nursing interventions
• Assists patients in care coordination with scheduling appointments with specialists.
• Conducts clinical follow-up calls
• Monitors the quality of patient care.
• Provides back up to support patient care functions
• Oversees the completion of annual competencies of assigned staff
• Performs other clinical duties as needed

Requirements

Experience: Two years of health-related care supervisory experience is preferred, but not required

Licenses or Certifications: Active RN licensure and valid BLS Certification