RN, Care Coordination

RN Care Coordinator

The RN Care Coordinator plays a pivotal role in managing and optimizing patient care across various healthcare settings to ensure seamless delivery of services. This position focuses on assessing patient needs, developing individualized care plans, and coordinating with multidisciplinary teams to facilitate effective care and follow-up. The RN Care Coordinator will act as a liaison between patients, families, healthcare providers, and community resources to promote continuity of care and improve health outcomes. By proactively identifying potential barriers to care and addressing them, the RN Care Coordinator helps reduce hospital readmissions and enhances patient satisfaction. Ultimately, this role contributes to the overall efficiency and quality of healthcare delivery by ensuring that patients receive timely, appropriate, and comprehensive care tailored to their unique needs.

Location: Salem Clinic Union Street | 1165 Union St NE, Salem OR 97301

Schedule: Monday - Friday 8-5 40 hrs/week

Minimum Qualifications:

• Current and valid Registered Nurse (RN) license in Oregon.
• Minimum of two years of clinical nursing experience, preferably in care coordination, case management, or a related field.
• Strong knowledge of healthcare systems, patient care protocols, and regulatory requirements.
• Proficiency in electronic health records (EHR) and Microsoft Office.

Preferred Qualifications:

• Experience working with diverse patient populations and chronic disease management.
• Advanced training or education in population health, health coaching, or patient advocacy.
• Excellent interpersonal and communication skills demonstrated in multidisciplinary team environments.
• Proficiency in Epic EHR.

Responsibilities:

• Conduct comprehensive patient assessments to identify healthcare needs and risks.
• Develop, implement, and regularly update individualized care plans in collaboration with healthcare teams.
• Coordinate communication among patients, families, physicians, specialists, and community resources to ensure cohesive care delivery.
• Monitor patient progress and outcomes, adjusting care plans as necessary to meet evolving health requirements.
• Educate patients and caregivers on disease management, treatment options, and available support services.
• Facilitate timely referrals and follow-ups to prevent gaps in care and reduce hospital readmissions.
• Participate in quality improvement initiatives aimed at enhancing care coordination processes and patient outcomes.

Skills:

The RN Care Coordination utilizes clinical expertise and critical thinking skills daily to assess patient conditions and develop effective care plans. Strong communication skills are essential for collaborating with patients, families, and healthcare providers to ensure clarity and alignment in care goals. Strong organizational skills enable the RN Care Coordinator to manage multiple cases simultaneously, track patient progress, and coordinate timely interventions. Proficiency with electronic health records and care management tools supports accurate documentation and data-driven decision-making. Additionally, strong problem-solving abilities help the RN Care Coordinator identify and overcome barriers to care, ensuring patients receive comprehensive and continuous support.