Position Purpose This position provides face to face, virtual or telephonic care. Collaborates with their team members both clinical and non-clinical. Coordinates services provided for patients with chronic, or behavioral health/chemical dependency needs across the lifespan to improve the quality of care and satisfaction. Identifies social determinants of health and clinical symptomology needing intervention and works within the framework of the IDT to build a longitudinal plan of care and satisfy goals. Nature and Scope This position shall coordinate all components of Care Coordination services to provide for individual patients health care needs thorough the continuum of care. This includes: Care Coordination which involves deliberately organizing patient care activities and sharing information among all the participants concerned with a patients care to achieve safer, and more effective care. This means patients needs and preferences are known ahead of time and communicated at the right time to the right people, and that this information is used to provide safe, appropriate, and effective care to the patient. The Care Coordinator will follow the Renown policies and procedures. The Care Coordinator will follow the Care Coordination Model of Care and Standard work as defined by CMSA. The scope includes potential for cross training within the department Care Coordination roles to cover for departmental vacations, illness and vacancies. Position will be responsible for the following: 1. Strong interpersonal communication skills both verbal and written. 2. Remains productive and offers help and support to team members.. 3. Collaborate with the patient, family, providers and team members to develop a patient centered Plan of Care and support patient with self-management goals. 4. Coordinates alternative community resources to include Home Health Care, REMSA, Durable Medical Equipment, Social Determinants and Community Partners to promote and assist the patient to have a safe environment of their choice and in alignment with the patient. 5. Facilitate, problem solve with patients, families, providers and other health care professionals to effectively resolve patient care issues. 6. Understands how to navigate Care Coordination process of Assessment, Planning, Goal Setting, Intervention, and Evaluation with the ability to utilize these components to provide for the individual health care needs and promote positive outcomes (quality). 7. Helps with transitions of care and organizes medical information.. 8. Knowledge of applicable regulatory requirements and community resources 9. Knowledge of continuous quality improvement process. 10. Philosophy consistent with the corporate culture of Renown Health 11. Initiates, updates and revises: Assessments, Patient Outreach Encounter documentation and Longitudinal Plan of Care within the Health Planet module in Epic 12. Ability to document in the MIDAS system any grievances, complaints, or compliments identified May be responsible for other duties as assigned. This position may be patient facing, in person, e-visits, home visit, virtual or telephonic. Disclaimer The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job. Minimum Qualifications Requirements - Required and/or Preferred Name Description Education: Must have working-level knowledge of the English language, including reading, writing and speaking English. Appropriate education to obtain and maintain Registered Nursing licensure in the State of Nevada. Experience: Requires one year experience as an RN, two years preferred. Applicants with Care Management or Home Health experience preferred. License(s): Valid State of Nevada or California driver's license and ability to pass Renown Health's Department of Motor Vehicle Report criteria. 200741, 530346 Ability to obtain and maintain a State of Nevada RN license. Additional State of California Registered Nurse license preferred. 530352 and 530353: Ability to obtain and maintain a State of Nevada RN license. Certification(s): Utilization or Case Management Certification desirable. Computer / Typing: Must possess, or be able to obtain within 90 days, the computers skills necessary to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.