RN Care Coordinator: PCMH Pod Lead

Community Health Center; Fort Dodge (IA); On-site; USD 65,000 - 85,000; Full time

Job summary

Community Health Center in Fort Dodge, IA is seeking a PCMH Pod Coordinator to lead care coordination within a dedicated care team. You will support outreach, pre-visit planning, and medication review, collaborating with medical, dental, behavioral health, and admin teams to improve access and outcomes.

This full-time role requires RN licensure and strong communication; Epic experience is preferred to support efficient care coordination and patient education in a busy clinic setting.

Qualifications

• RN licensed and eligible to practice.
• 1+ year experience in care coordination or clinical support.
• Knowledge of PCMH model and quality metrics (UDS, HEDIS, ACO).
• Strong communication and interpersonal skills.
• Proficient with EHRs (Epic preferred) and Microsoft Office.

Responsibilities

• Conduct daily team huddles to review schedules and coordinate outreach.
• Review Epic Outside Events In-Basket messages and route to providers and care team members.
• Coordinate post-discharge follow-up and care transitions.
• Monitor referrals and document accommodations or barriers to care.
• Identify high-risk patients and assist with chronic condition management.

Skills

Care coordination

Patient outreach

Communication

Multidisciplinary teamwork

Independent work

Education

RN license

Tools

Epic

Microsoft Office

Job description

Community Health Center in Fort Dodge, IA is seeking a PCMH Pod Coordinator to lead care coordination within a dedicated care team. You will support outreach, pre-visit planning, and medication review, collaborating with medical, dental, behavioral health, and admin teams to improve access and outcomes.

This full-time role requires RN licensure and strong communication; Epic experience is preferred to support efficient care coordination and patient education in a busy clinic setting.