RN Clinical Coordinator - Field Based in Union and Surrounding Counties - New Jersey
- Engage members face-to-face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic needs
- Develop and implement person centered care plans to address needs including management of chronic health conditions, health promotion and wellness, social determinants of health, medication management and member safety in alignment with evidence-based guidelines
- Partner and collaborate with internal care team, providers, and community resources/partners to implement care plan
- Provide education and coaching to support member self-management of care needs and lifestyle changes to promote health
- Support proactive discharge planning and manage/coordinate Care Transition following ER visit, inpatient or Skilled Nursing Facility (SNF) admission
- Advocate for members and families as needed to ensure the member's needs and choices are fully represented and supported by the health care team
- Current, unrestricted independent licensure as a Registered Nurse
- 2+ years of clinical experience
- 1+ years of experience with MS Office, including Word, Excel, and Outlook
- Driver's License and access to reliable transportation and the ability to travel up to 80% of your time within assigned territory to meet with members and providers
- BSN, Master's degree or higher in clinical field
- CCM certification
- 1+ years of community case management experience coordinating care for individuals with complex needs
- Experience working in team-based care
- Background in managed care
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