RN Transitions & Care Coordinator - CAP Case Management

capefearvalley; United States; On-site; USD 65,000 - 85,000; Full time

Job summary

Cape Fear Valley Health System seeks an experienced RN for the Community Alternatives Program Services in Fayetteville, NC. You will perform nursing assessments, educate CAP beneficiaries, and coordinate care with the interdisciplinary team and Health Benefits as outlined in policy.

The role emphasizes transition coordination to and from acute care, LTAC, rehab, SNF and home care, maintaining a caseload and providing whole-person care coordination. Documentation is via e-CAP and EPIC.

Qualifications

• Associate's degree in nursing is required.
• Bachelor's degree in nursing is preferred.
• Current RN licensure in North Carolina or a Compact state.

Responsibilities

• Performs nursing assessments for CAP beneficiaries and documents findings.
• Provides case management and care coordination to a caseload.
• Coordinates transitions to and from acute care and other settings.
• Formulates care plans with person-centered goals in collaboration with the team.
• Monitors services monthly to quarterly and supports follow-up after discharge.
• Completes documentation in e-CAP and EPIC in a timely manner.
• Participates in performance improvement activities.
• Develops resources through grants and interdepartmental networking.

Skills

English proficiency

Interpersonal skills

Communication

Organizational skills

Critical thinking

Education

Associate's degree in nursing

Bachelor's degree in nursing preferred

Job description

Cape Fear Valley Health System seeks an experienced RN for the Community Alternatives Program Services in Fayetteville, NC. You will perform nursing assessments, educate CAP beneficiaries, and coordinate care with the interdisciplinary team and Health Benefits as outlined in policy.

The role emphasizes transition coordination to and from acute care, LTAC, rehab, SNF and home care, maintaining a caseload and providing whole-person care coordination. Documentation is via e-CAP and EPIC.