Career Center
Durham, North Carolina
Fredericksburg, Virginia
Meridian, Idaho, Idaho
Posted: 10-May-23
Location: Lewes, Delaware
Salary: Open
Categories:
Internal Number: 8230
JOIN OUR NURSE VIRTUAL CHATS EACH THURSDAY FROM 2PM - 3PM
This is a Monday through Friday position working in the physician practice located in Georgetown, DE.
Summary:
The RN Care Coordinator functions as an extension of the provider and positively impacts the patient's quality of care and ability to access care, reduces unnecessary costs and generates revenue. Key functions include building relationships with patients, functioning as a team member in the practice and the patient's continuum of care, increasing patient experience, performing annual Medicare wellness exams, mitigating hospital readmissions, closing care gaps, and identifying social determinant of health barriers that impact the patient's ability to maintain optimal health and wellness.
Other information:
3-5 years of experience working as an RN and also experience working in care coordination, care management or case management.
RN license in the state of Delaware or compact state.
Primary Care or physician office experience preferred. Experience performing annual well visits desirable
Responsibilities:
Improve quality by closing care gaps a. Medicare annual wellness exam b. Breast cancer screening c. A1C >9 d. HTN <140 f. Increasing h. Depression to 3. 90 patients care access screening Fall Increase PCP resources: Colorectal see risk a. additional e. g. admissions healthcare and 2. costs nephropathy of unnecessary hospital time utilization by preventing Reduce Diabetic>e. Fall risk screening f. Depression screening g. Diabetic nephropathy screening h. Colorectal screening 2. Increase access to care by a. Increasing PCP time to see additional patients 3. Reduce costs by preventing hospital admissions and unnecessary utilization of healthcare resources: a. Ensure TCM calls and visits are completed for post-hospital patients. i. Address social determinant of health barriers 1.Transportation to/from appointments and for necessities (groceries, pharmacy, etc.) 2. Ability to obtain and afford medications ii. Self-management of reason for being in hospital and chronic conditions iii. Address behavioral health needs b. Care-manage high-risk patients with chronic conditions and high RAF scores: COPD, CHF, Diabetes, HTN, and increased acute care and ED utilization 4. Generate additional revenue a. Identification of and scheduling problem office visits (following MAWE or separate visit) b. Ensure bi-annual visits with PCP c. Ensure optimized visit scheduling for managing chronic conditions 5. Employee/Provider Engagement a. Demonstrate effective communication, collaboration, and team-based mentality b. Demonstrate ability to build relationships with patients c. Function as a team member within the practice d. Communicate with providers/clinical team about daily patient schedule e. Participate in daily huddles/team meetings. Other duties as assigned.
Credentials:
Essential:
* RN - Registered Nurse
* BLS - Basic Life Saving certification
Competencies and skills:
Essential:
* Clear Communication Skills Both Written And Verbal
* Able To Keep Confidential Information Regarding Patients, Team Members
* Able To Withstand Crisis Situations
* Has Skills To Provides Customer Service To Patients, Team Members And Visitors
* Knowledge And Experience With Electronic Health Records
Education:
Essential:
* Associates Degree/Diploma in Nursing; BSN preferred
Location: Carpenter's Way
Shift : 8am-4:30pm Monday - Friday
FTE: 1.000000
Work Status: Full Time
