RN Care Navigator for Community Health Impact

Nmpca; Santa Fe (NM); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Medical, dental, vision

Life insurance

Long-term and short-term disability

401k retirement plan

CME reimbursement

Job summary

Southwest Care Center in Santa Fe, NM is seeking a Registered Nurse Care Coordinator to join our primary and specialty care clinics. You will participate in identifying high risk patients, manage hospital admissions/discharges, and coordinate post-discharge care with patients and care teams.

The role emphasizes medication reconciliation, resource linkage, and patient education to empower individuals in managing their health and navigating the care system.

Responsibilities

• Participate in identification of high risk/high acuity patients.
• Identify and follow up on hospital and emergency department admissions and discharges.
• Oversee care transitions (hospital to home, hospital to rehab/nursing facility) and coordinate follow up with patient.
• Initiate patients' medication reconciliation.
• Oversee patients' linkages to community resources and social support.
• Coordinate with primary care providers, behavioral health specialists and outside providers.
• Promote patient independence by teaching and counseling patients and family on disease, medications, and self-care.

Job description

Southwest Care Center in Santa Fe, NM is seeking a Registered Nurse Care Coordinator to join our primary and specialty care clinics. You will participate in identifying high risk patients, manage hospital admissions/discharges, and coordinate post-discharge care with patients and care teams.

The role emphasizes medication reconciliation, resource linkage, and patient education to empower individuals in managing their health and navigating the care system.