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. # #

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.