RN Care Coordinator - FT Days - GROVE Family Practice
Company: Integris Health
Posted on: October 7, 2021
RN Care Coordinator - Full Time Days - Grove Family
Practice, Grove, OK
Job Code: 1335
Through collaborative practice, the RN Care Coordinator will
facilitate communication and care coordination activities along the
care continuum recognizing the patient's right to
self-determination, the significance of the social determinants of
health and care complexities. In a targeted patient population, the
RN Care Coordinator assist patients to achieve optimal health,
access to services, education, and appropriate utilization of
INTEGRIS is an Equal Opportunity/Affirmative Action Employer. All
applicants will receive consideration regardless of membership in
any protected status as defined by applicable state or federal law,
including protected veteran or disability status.
The RN Care Coordinator responsibilities include, but are not
limited to, the following:
• Assess patients for clinical, psychosocial, financial and other
factors that may affect the quality and health outcomes.
• Evaluates the potential impact of social determinants of health
that may elevate the patient's risk in achieving optimal health
• Collaborates with the care team to provide high quality,
cost-effective, patient centered care.
• Provide patient education.
• Collaborate with patients/families/caregivers in goal setting,
evaluates the level of understanding and engagement with the
progress toward goals, and incorporates findings into the plan of
• Arranges services among community agencies, provider,
patient/family/caregivers and others involved in the plan of
• Utilizes shared decision making with the
patient/families/caregivers, develops a plan that is clinically
appropriate and focused on the patient's care needs and goals for
care and treatment plan that is consistent with patient choice and
• Identifies barriers to achieving recommended goals identified in
the plan of care.
• Promote wellness and provide education regarding preventative
• Completed Transitional Care Management per departmental key
process standard work.
• Identify root cause for readmission to include patient/
family/caregiver perspective and implement strategies to reduce
• Convey all necessary information for continuity of care and
patient safety, verify receipt and provide a venue for additional
• Identify available community resources/potential partners and
advocate for resolution of gaps in the available resources and
• Support a mechanism to ensure a method of contacting the
patient/family/caregiver within a timeframe appropriate to the site
of care in order to validate the success of the transition and make
their best effort to resolve any identified barriers to the plan of
• Documentation is included in the patient's medical record and
readily accessible to all other care team members.
• Knowledgeable of and ensure compliance with the federal, state,
local organization and accreditation requirements that not only
impact their scope of services but affect their ability to advocate
for the patient. Case Management organizational structure,
staffing, policies and procedures must meet the Centers for
& Medicaid Services (CMS) Conditions of Participation.
• All disciplines function within the scope of practice as defined
by state licensing regulations.
• Case Management adheres to organizational policies, rules and
regulations to promote prevention of fraud and abuse
Reports to assigned Director or Manager.
Required Physical Demands (Subject to Reasonable
Keyboarding/Dexterity: Frequently; activity exists from 1/3 to 2/3
of the time
Standing/Walking: Occasionally; activity exists up to 1/3 of the
Strength (Lift/Carry/Push/Pull): Sedentary (exerting up to 10
pounds of force occasionally)
Talking (Must be able to effectively communicate verbally): Yes
Color Acuity (Must be able to distinguish and identify colors):
This position may have additional or varied physical demand and/or
respiratory fit test requirements. Please consult the Physical
Demands Project SharePoint site or contact Risk Management/Employee
Health for additional information.
Normal office environment. When working in clinical areas,
potential for exposure to infections and communicable diseases,
blood and body fluids, electrical equipment, chemicals. Must follow
All applicants will receive consideration regardless of membership
in any protected status as defined by applicable state or federal
law, including protected veteran or disability status.
• Current licensure as a Registered Nurse (RN) in the State of
Oklahoma or current multistate license from a Nurse Licensure
Compact (eNLC) member state
• Bachelors degree in Nursing preferred
• Minimum of 3 years recent clinical experience in a variety of
• Must obtain BLS within 90 days of hire and renew according to
• Care Management or Care Coordination experience preferred
• Excellent interpersonal communication and collaboration
• Computer experience required. Windows and Excel preferred.
• This job requires the incumbents to operate a INTEGRIS-owned
vehicle OR personal vehicle (non INTEGRIS-owned) and therefore must
have a current Oklahoma State Drivers License as well as a driving
record which is acceptable to our insurance carrier
Keywords: Integris Health, Fayetteville , RN Care Coordinator - FT Days - GROVE Family Practice, Other , Fayetteville, Arkansas
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