RN Care Coordinator -Part Time

Provider Partners; Philadelphia (Philadelphia County); On-site; USD 60,000 - 80,000; Full time

Job summary

A leading health plan provider in Philadelphia seeks a Nurse Care Coordinator to enhance care coordination for members with chronic conditions. This role involves assessing and planning holistic care approaches, collaborating with interdisciplinary teams, and ensuring effective communication. Candidates should have an unrestricted RN license and at least 3 years of clinical experience, with a background in skilled nursing or case management preferred. Strong problem-solving skills and proficiency in medical databases are essential for success in this position.

Qualifications

• Minimum of 3 years clinical care experience.
• Skilled Nursing Facility/Long Term Care experience preferred.
• Case management experience preferred.

Responsibilities

• Case identification/risk stratification for PPHP members.
• Collaboration with the Transitional Care Team.
• Conducting comprehensive assessments of barriers to care.
• Coordinating care plan development with the interdisciplinary team.
• Documentation of care plans in the gEHRimed EMR.
• Management and evaluation of care outcomes.

Skills

Nursing expertise in managing complex cases

Excellent critical thinking

Interpersonal communication

Organizational skills

Multi-tasking

Teamwork

Proficient in nursing/medical databases

Proficient in Microsoft programs

Education

Current unrestricted RN license

Job description

Job Summary

The Nurse Care Coordinator will play a key role in the execution of the Provider Partners Health Plan (PPHP) Model of Care (MOC) through the collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet the comprehensive health needs of each member of the PPHP program. Utilizing effective communication skills and available resources, the Nurse Care Coordinator will promote quality, cost‑effective outcomes, including care coordination for complex and multiple chronic conditions of the long‑term care resident.

Key Responsibilities

• Case identification/risk stratification to establish needs of the PPHP member.
• Collaboration with the Transitional Care Team to reduce re‑admissions and avoid inappropriate hospitalizations.
• Conducting and documenting a comprehensive assessment of barriers to care (medical, social, psychosocial, and literacy) promoting a holistic approach to developing the PPHP member’s plan of care.
• Coordinating integrated care plan development, including collaboration with nursing staff, leadership, and the entire interdisciplinary team according to the PPHP MOC.
• Facilitation of developing appropriate referrals/consultations.
• Documentation of care plans in the gEHRimed EMR.
• Outcomes management and evaluation of the achievement of established goals within the plan of care.
• Ensures initial and annual follow‑up Model of Care training occurs for employees, providers and contracted personnel associated with the ISNP program.

Qualifications

• Current unrestricted RN license for the state in which the Nurse Care Coordinator is practicing.
• Minimum of 3 years clinical care experience.
• Skilled Nursing Facility/Long Term Care experience preferred.
• Case management experience preferred.
• Strong nursing expertise in managing complex cases with minimal supervision.
• Knowledge of current standard medical practices and experience with Medicare/Medicaid.
• Ability to work with and communicate on a professional level with the interdisciplinary team.
• Excellent independent critical thinking/problem‑solving skills.
• Excellent oral and written interpersonal communication, organizational, multi‑tasking, and teamwork skills.
• Proficiency in nursing/medical databases and Microsoft programs.
• Positive and enthusiastic attitude.
• Valid driver’s license and car insurance with reliable transportation.