RN Care Coordinator: Chronic Care Advocate & Planner

Crouse Hospital Auxiliary, Inc.; City of Syracuse (NY); On-site; USD 69,000 - 83,000; Full time

Benefits offered by this job

Health/Dental/Vision & Life insurance

Flexible spending account or Health-sy

15 days of paid time-off

7 paid holidays annually

401k with 4% employer match

Tuition reimbursement

Employee referral program

Affiliation with Crouse Hospital

Job summary

Crouse Medical Practice in Syracuse, NY is hiring an RN Care Coordinator for Chronic Care Management (CCM) serving Medicare beneficiaries. You will act as a proactive advocate, educator, and care manager, coordinating across the care continuum to improve outcomes and reduce unnecessary utilization.

The role emphasizes relationship-building, regular outreach, and development of comprehensive care plans. Benefits include health insurance and tuition reimbursement, with competitive starting rates

Qualifications

• Current NYS RN license.
• Strong interpersonal communication skills.
• Experience in case management, population health, or care coordination preferred.
• Familiarity with EMR systems and Microsoft Office.
• Commitment to culturally humble and sensitive care.

Responsibilities

• Serve as primary contact and health advocate for Medicare patients with two or more chronic conditions.
• Build long-term rapport through monthly outreach and routine communication.
• Assess physical, emotional, social, and environmental needs.
• Develop and update a patient-centered care plan in the EMR.
• Promote self-management and health literacy through coaching and goal setting.
• Coordinate services across primary, specialty, behavioral health, pharmacy, and social services.
• Prevent avoidable hospitalizations with timely follow-up and medication review.
• Support transitions of care with communication and follow-ups.

Skills

Interpersonal communication

Motivational interviewing

Care coordination

EMR experience

Education

Associate's Degree in Nursing

BSN preferred

Tools

EMR systems

Microsoft Office

Job description

Crouse Medical Practice in Syracuse, NY is hiring an RN Care Coordinator for Chronic Care Management (CCM) serving Medicare beneficiaries. You will act as a proactive advocate, educator, and care manager, coordinating across the care continuum to improve outcomes and reduce unnecessary utilization.

The role emphasizes relationship-building, regular outreach, and development of comprehensive care plans. Benefits include health insurance and tuition reimbursement, with competitive starting rates