Care Coordination Registered Nurse

2 weeks ago


Edinburg, Texas, United States Regency Integrated Health Services Full time
Position Title: Care Coordination Registered Nurse (RNCC)

Job Overview
Level: Experienced
Employment Type: Full Time

Educational Requirements:
2 Year Degree

Salary: Undisclosed

Category: Health Care

Key Responsibilities
The RNCC collaborates with the Nurse Practitioner of the Texas Independence Health Plan Institutional Special Needs Plan (ISNP) to manage and coordinate care for ISNP Beneficiaries. This role involves maintaining regular communication with Plan Members, their families, and facility personnel, while also notifying the Nurse Practitioners and/or facility staff of any potential medical, emotional, or behavioral changes in a Plan Member's condition.

Core Duties:
  • Assist the Nurse Practitioner with care coordination tasks and documentation for Plan Members. May conduct assessments with Plan Members, including vital signs and other essential data.
  • Conduct daily evaluations to monitor changes in Plan Members' health status, as well as maintain a daily census, documenting and reporting to Nurse Practitioners any transfers to hospitals, hospice care decisions, or recent hospital returns.
  • Collaborate with facility staff and the Interdisciplinary Care Team (ICT) to execute care plans for Plan Members and facilitate the coordination of specialty services, therapies, and referrals.
  • Monitor Plan Members experiencing health changes and transitions to and from healthcare settings, ensuring timely communication with the hospital and updating the Nurse Practitioner on the Plan Member's status.
  • Conduct follow-up visits with each Plan Member post-transition to assess their risk for readmission and communicate any emerging medical needs to the Nurse Practitioner.
  • Promptly inform the Nurse Practitioner of new enrollees and emphasize the urgency of intervention for at-risk Plan Members.
  • Perform additional duties as assigned in alignment with the ISNP Plan.

Qualifications
Educational Requirements:
Associate Degree in Nursing (ADN), current Board Certification

Licensing:
Registered Nurse (RN)

Experience:
The RNCC must adhere to all State and Federal regulations necessary for practicing as a licensed Registered Nurse, including maintaining an active RN license in Texas. The RNCC is also responsible for fulfilling ongoing educational requirements set by the Texas Board of Nursing for licensure and re-certification.
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