Registered Nurse (RN) - Care Coordinator - Care Management - Full-Time
Role Summary This position involves establishing and maintaining an efficient, cost-effective care management process, including assessing patient eligibility, developing care plans, and coordinating care to ensure high-quality, patient-centered outcomes. The role requires collaboration with healthcare teams, monitoring progress, addressing barriers, and ensuring appropriate resource utilization and discharge planning. Responsibilities include conducting patient assessments, applying utilization review criteria, managing transitions within the healthcare system, and supporting performance improvement initiatives. The role also entails communication with patients, families, and payers, advocating for appropriate coverage, and documenting care activities. Qualifications \& Skills * Graduate of an accredited Nursing school with a valid RN license (Texas or Compact license) * At least 2 years of hospital or community-based nursing experience * Current BLS certification * Effective communication and collaboration skills with diverse populations * Knowledge of disease processes, healthcare laws, and regulations related to Medicare, Medicaid, and community funding * Strong organizational skills, self-direction, and problem-solving abilities * Proficiency in PC operations, word processing, and understanding of healthcare funding sources Key Responsibilities * Assess patients to develop individualized care plans, determine funding sources, and evaluate eligibility. * Collaborate with healthcare teams and patients to implement and monitor care plans, ensuring quality and efficiency. * Communicate care plans, reassess effectiveness, and coordinate discharge needs and community resources. * Manage utilization activities, monitor length of stay, and ensure appropriate resource use. * Identify and address outcome variances, support cost containment, and improve performance metrics. * Facilitate payer communication for authorization and reimbursement, resolving issues as needed. * Coordinate patient transitions across care settings, promoting health education, prevention, and resource linkage. * Participate in special projects and committees to enhance care management processes.