RN: Primary Care Care Coordinator for Chronic Conditions

Mayo Clinic; Austin (MN); On-site; USD 50,000 - 81,000; Full time

Benefits offered by this job

Medical plan options

Dental coverage

Vision coverage

HSA/FSAs

Retirement plan

Job summary

Mayo Clinic in Minnesota seeks an experienced Registered Nurse (RN) to support patients with chronic conditions transitioning from hospitalization back to Primary Care. The role emphasizes motivation interviewing, care coordination, and collaborative health care within a dedicated nursing team.

The RN will conduct post-hospital follow-up calls, perform in-home visits for care coordination, and partner with primary care providers to implement individualized plans.

Qualifications

• Graduate of a baccalaureate nursing program, as recognized by ACEN/CCNE/NLN CNEA.
• One year RN experience in an applicable care setting or one year LPN experience at Mayo Clinic preferred.
• Evidence of program completion of the baccalaureate degree within five years for certain start dates.
• Current RN license by state requirements; BLS competency may be required by location.
• Excellent communication, teamwork, and ability to use electronic medical records.

Responsibilities

• Post-hospital follow-up calls for patients at risk of readmission.
• In-home visits for care coordination after discharge, including medication reconciliation and safety assessment.
• Collaborate with primary care providers to develop and monitor care plans.
• Manage a defined patient panel with ongoing follow-up and coordination.
• Educate patients on chronic conditions and medications to promote engagement.

Skills

RN experience

Excellent communication

Leadership

Critical thinking

EMR experience

Education

Bachelor's degree in nursing

RN license

Job description

Mayo Clinic in Minnesota seeks an experienced Registered Nurse (RN) to support patients with chronic conditions transitioning from hospitalization back to Primary Care. The role emphasizes motivation interviewing, care coordination, and collaborative health care within a dedicated nursing team.

The RN will conduct post-hospital follow-up calls, perform in-home visits for care coordination, and partner with primary care providers to implement individualized plans.