CARE COORDINATOR, RN

JOB SUMMARY

The Care Coordinator, RN is a staff position responsible for providing comprehensive care coordination services for complex and high-risk patients, including those with chronic health conditions. This role involves collaborating with healthcare providers, hospitals, and community-based organizations to ensure access to high-quality, cost-effective patient- and family-centered healthcare and social services. The Coordinator plays a pivotal role in optimizing patient care by managing treatment plans, facilitating communication between patients and the healthcare team, and providing support, education, and resources to promote self-management and adherence to treatment regimens.

KEY RESPONSIBILITIES:

• Conduct comprehensive assessments of patients with chronic health conditions to identify their unique needs and develop personalized care plans.
• Coordinate and facilitate communication between patients, primary care providers, specialists, and other healthcare professionals involved in the patient's care.
• Educate patients and their families about chronic conditions, treatment options, medication management, lifestyle modifications, and self-care techniques.
• Monitor patients' progress and adherence to treatment plans, conducting regular follow-ups to assess outcomes and address any barriers to care.
• Collaborate with community resources, social services, and support groups to connect patients with additional services and resources as needed.
• Document patient interactions, care plans, and interventions accurately and timely in electronic health records (EHR) or other designated systems.
• Participate in multidisciplinary team meetings to discuss patient cases, share insights, and contribute to care coordination efforts.
• Stay informed about advancements in chronic disease management, evidence-based practices, and healthcare policies to enhance the quality of care provided.
• Maintain confidentiality and adhere to ethical standards in handling patient information and sensitive medical data.
• Contribute to quality improvement initiatives aimed at enhancing patient outcomes, satisfaction, and overall healthcare delivery.
• Engages in PCMH and ACO initiatives to enhance patient-centered care and improve healthcare outcomes, Including assisting with any reporting responsibilities as assigned.
• All other duties as assigned.

BENEFITS

• Retirement plan with a generous employer contribution of 6% and a 1% match.
• Working with a friendly and supportive TEAM!
• Health, Dental, and Vision insurance (80% of the cost covered by employer).
• Generous earn time accrual rate.

QUALIFICATIONS

EDUCATION:

• Graduate of an RN-accredited nursing program; BSN preferred.

EXPERIENCE

• Minimum of 2-3 years of experience in care coordination and/or case management within a healthcare setting.

LICENSURE/CERTIFICATION(S):

• Vermont state RN license required.
• Current Healthcare Provider CPR certification
• Remains current with continuing education/CEU requirements.