RN Care Transitions & Care Coordination

Cape Fear Valley Health; Fayetteville (NC); On-site; USD 65,000 - 90,000; Part time

Job summary

Cape Fear Valley Health System seeks a Registered Nurse for transitions and care coordination within the Community Alternatives Program Services. The role supports CAP beneficiaries across acute and post-acute settings, maintaining a caseload and ensuring seamless, patient-centered care.

The RN collaborates with interdisciplinary teams, documents in EPIC and e-CAP, and participates in performance improvement activities while supporting home- and community-based care transitions.

Qualifications

• RN licensure in NC or compact state required.
• Two years’ acute care experience required.
• One year experience in case management or care coordination preferred.
• CCM certification preferred.

Responsibilities

• Perform nursing assessments for CAP beneficiaries.
• Provide case management and care coordination to assigned caseload.
• Coordinate transitions to reduce hospital stay and avoid readmissions.
• Develop care plans with beneficiaries and support networks.
• Document timely in e-CAP and EPIC systems.

Skills

English proficiency

Interpersonal skills

Communication

Organizational skills

Critical thinking

Education

Associate degree in nursing

Bachelor’s degree in nursing

Tools

EPIC

e-CAP

Job description

Cape Fear Valley Health System seeks a Registered Nurse for transitions and care coordination within the Community Alternatives Program Services. The role supports CAP beneficiaries across acute and post-acute settings, maintaining a caseload and ensuring seamless, patient-centered care.

The RN collaborates with interdisciplinary teams, documents in EPIC and e-CAP, and participates in performance improvement activities while supporting home- and community-based care transitions.