RN Care Coordinator

3 weeks ago


Santa Maria, California, United States Community Health Centers of the Central Coast Full time
Job Summary

We are seeking a highly skilled RN Care Coordinator to join our team at Community Health Centers of the Central Coast. As a RN Care Coordinator, you will play a critical role in ensuring the coordination of care for our patients, working closely with our multidisciplinary care team to achieve optimal outcomes and wellness.

Key Responsibilities
  • Conduct intake assessments, needs assessments, treatment planning, and reassessments to ensure comprehensive care coordination.
  • Provide day-to-day support, supervision, and performance reviews for Hospital Discharge and ER Follow-Up Coordinators and Patient Navigators.
  • Review patient cases with Hospital Discharge and ER Follow-Up Coordinators and Patient Navigators, providing advice, direction, and support as needed.
  • Organize or lead training sessions for Hospital Discharge and ER Follow-Up Coordinators and Patient Navigators.
  • Provide clinical supervision to Hospital Discharge and ER Follow-Up Coordinators and Patient Navigators.
  • Screen clients for eligibility for direct and support services, referring clients to needed services such as mental health, housing, crisis, and employment assistance.
  • Facilitate Care Team meetings with Hospital Discharge and ER Follow-Up Coordinators, Patient Navigators, and healthcare providers to discuss client care plans and share information regarding referral sources.
  • Document client services in medical records.
  • Establish and retain client referral systems from care coordination systems.
  • Maintain documentation of all client encounters and complete reporting requirements according to organization standards.
  • Track client information, schedules, files, and forms in a confidential manner.
  • Initiate outreach and missed appointment procedures, as per CHCCC policy.
  • Monitor medication management as directed by clinician and within scope of practice.
  • Attend and represent the organization at professional conferences, in-service trainings, and meetings at the request of or with the approval of supervisor.
Requirements
  • Graduation from an accredited School of Nursing.
  • Associate Degree in Nursing required; BSN preferred.
  • Minimum five (5) years of nursing experience with a minimum of two (2) years in care coordination/case management experience.
  • Knowledgeable about Federally Qualified Health Centers and Value-Based Care.
  • Demonstrates strong interpersonal skills.
  • Demonstrates knowledge of Nursing Practice, TJC, and other local, state, and federal agencies.
Working Conditions

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job.

While performing the duties of this job, the employee is frequently exposed to moving mechanical parts. The employee is occasionally exposed to risk of electrical shock. The noise level in the work environment is usually moderate.

Must be willing to have a flexible work schedule that may include evenings/weekends, and travel as needed.


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