RN Continuing Care Coordinator

Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation’s largest nonprofit Catholic healthcare organizations, CommonSpirit Health delivers more than 20 million patient encounters annually through more than 2,300 clinics, care sites and 137 hospital-based locations, in addition to its home-based services and virtual care offerings. CommonSpirit has more than 157,000 employees, 45,000 nurses and 25,000 physicians and advanced practice providers across 24 states and contributes more than $4.2 billion annually in charity care, community benefits and unreimbursed government programs. Together with our patients, physicians, partners, and communities, we are creating a more just, equitable, and innovative healthcare delivery system.

CHI Health has an immediate need to add an RN Continuing Care Coordinator to our 42nd & L St Family Clinic! 

Schedule: Monday-Friday 8a-5p, NO weekends, NO holidays & NO call! 

Job Summary

With guidance from the local market leadership, the Continuing Care Coordinator RN works collaboratively with physicians, staff and other health care professionals within his/her clinically setting to maintain and improve quality and sustainability within the local market network, this work includes: 

• Chronic Disease Management—Develops a plan of care based on a nursing assessment of the patient and their individual circumstances. The plan of care will include patient and caregiver education as well as coordination and collaboration of care with an interdisciplinary team working with that patient. The RN will also be responsible for monitoring the patient’s progress with the care plan. 
• Practice Pattern Management—Referral Management, based upon local program criteria
• Performance Data Interpretation—Participates in development of workflows and audits
• Evidence-Based Metric (EBM) guidelines / care plans—Implements and hardwires different EBM guidelines in the ambulatory setting as well as facilitating seamless transitions of care between clinic and post-acute settings and between clinic and other health professionals.

Minimum Qualifications:

• Current Registered Nurse (RN) license that allows you to practice in our state
• Graduate of an accredited nursing program (BSN Preferred but NOT required)
• Basic Life Support (BLS) from the American Heart Association required