RN CARE COORDINATOR

4 weeks ago

Flemington NJ USA, United States Hunterdon Healthcare Full time
RN Care Coordinator # This innovative position places the registered nurse (RN) in a Care Coordinator role partnering with primary care providers.# The majority of our primary care practices are certified Patient-Centered Medical Homes (PCMH).# The Medical Home Care Coordinator is a vital part of the multidisciplinary healthcare team which strives to coordinate care and optimize outcomes for patients and our healthcare system.# # Care Transition Coaching and Coordination ####### Reduce unnecessary hospitalizations and re-hospitalizations by working with patients who were discharged from various healthcare facilities.# Work with the primary care team to ensure follow-up visits are scheduled within 48 hours of facility discharge. ####### Use Motivational Interviewing and coaching strategies to help patients identify and meet their healthcare goals. ####### Develop individualized care plans to help patients track and meet their goals. ####### Provide care coordination strategies via telephonic support and/or face-to-face to engage and educate patients.#### ####### Develop and promote constructive relationships with inpatient, outpatient and community personnel to meet patient needs and goals. ####### Guide process and performance improvement initiatives in the primary care setting to meet strategic goals.# ####### Engage with home care agencies, specialists, and any other integral providers or resources in case management activities. Population Management ####### Prioritize high risk patient needs with physicians, office staff, and the health care team. ####### Leverage clinical informatics to identify high risk, high need, and potentially high cost patients of the medical home to manage their care.# ####### Utilize electronic medical record (EMR) and chronic disease registry reporting to prioritize patient outreach.# ####### Coordinate with Case Management and Disease Management staff when applicable # Qualifications Education/Experience: ####### RN licensure required.# #BSN preferred. ####### Certified Case Management (CCM) preferred ####### Five to eight years of direct patient care experience required ####### Must have experience with Microsoft Office (Word, Excel, PowerPoint).# ####### Must possess the ability to quickly learn new IT systems and software.# ####### Must be able to adjust and prioritize tasks in a dynamic environment. ####### Experience with an EMR strongly preferred ####### Experience analyzing, sorting and drawing conclusions from data strongly preferred. #

RN Care Coordinator

This innovative position places the registered nurse (RN) in a Care Coordinator role partnering with primary care providers. The majority of our primary care practices are certified Patient-Centered Medical Homes (PCMH). The Medical Home Care Coordinator is a vital part of the multidisciplinary healthcare team which strives to coordinate care and optimize outcomes for patients and our healthcare system.

Care Transition Coaching and Coordination

* Reduce unnecessary hospitalizations and re-hospitalizations by working with patients who were discharged from various healthcare facilities. Work with the primary care team to ensure follow-up visits are scheduled within 48 hours of facility discharge.
* Use Motivational Interviewing and coaching strategies to help patients identify and meet their healthcare goals.
* Develop individualized care plans to help patients track and meet their goals.
* Provide care coordination strategies via telephonic support and/or face-to-face to engage and educate patients.
* Develop and promote constructive relationships with inpatient, outpatient and community personnel to meet patient needs and goals.
* Guide process and performance improvement initiatives in the primary care setting to meet strategic goals.
* Engage with home care agencies, specialists, and any other integral providers or resources in case management activities.

Population Management

* Prioritize high risk patient needs with physicians, office staff, and the health care team.
* Leverage clinical informatics to identify high risk, high need, and potentially high cost patients of the medical home to manage their care.
* Utilize electronic medical record (EMR) and chronic disease registry reporting to prioritize patient outreach.
* Coordinate with Case Management and Disease Management staff when applicable

Qualifications

Education/Experience:

* RN licensure required. BSN preferred.
* Certified Case Management (CCM) preferred
* Five to eight years of direct patient care experience required
* Must have experience with Microsoft Office (Word, Excel, PowerPoint).
* Must possess the ability to quickly learn new IT systems and software.
* Must be able to adjust and prioritize tasks in a dynamic environment.
* Experience with an EMR strongly preferred
* Experience analyzing, sorting and drawing conclusions from data strongly preferred.

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