ACO Registered Nurse Care Coordinator

North Country Healthcare • Full-time • Lancaster, NH, US • 3m ago

Job Summary:

The Medical Practice RN Care and Clinical Coordinator is responsible for working collaboratively with a multidisciplinary care team across the healthcare continuum in the outpatient setting. This includes but is not limited to, managing patients with chronic conditions, promoting wellness and ensuring smooth transitions of care. Focuses efforts on decreasing preventable ED visits and readmissions while improving patient satisfaction. She/he will be responsible for ACO and Quality incentive programs as well as clinical quality, oversight, coordination, and standardization. The RN care and clinical coordinator is responsible for optimizing workflow and improving efficiency.

Essential Job Functions:

Assists with the management of chronic care patients, provides health teaching, advocacy, counseling and assistance to a group or population of patients including but not limited to chronic care patients, high risk for readmission and support what is in the best interest of the patient.
Support ACO initiatives and support the provision of staff education relative to quality improvement. Responsible for working on quality initiatives with insurance carriers to promote wellness and shared savings.
Promote healthy behaviors in all populations and ensure navigation assistance with community resources.
Promote quality driven work processes that optimize workflow and improve office efficiency.
Promote a culture of shared responsibility in which processes are standardized across clinics. Work in conjunction with practice managers to achieve improvement.
In conjunction with healthcare providers as well as other leaders strive to establish efficient clinical processes as it relates to ACO initiatives and quality improvement.
Promote a work environment which fosters the acceptance of positive change initiatives.
Demonstrates professional practice behavior.
Demonstrates understanding in use of IT resources and patient databases.
Works closely with all primary care teams, hospital department staff, home health agencies and other care coordinators to ensure the patients experience a smooth transition of care across all health care settings.
Work in conjunction with palliative care provider, including but not limited to processing incoming palliative care referrals, scheduling palliative appointments, providing follow up with palliative care patients.

Education Requirements:

Registered Nurse Degree Required.

About WMC:

The major strength of Weeks Medical Center is found in the ability of our physicians and staff to offer extensive services utilizing state-of-the-art technology while maintaining the personalized care of a community hospital. Weeks is a 25-bed critical access hospital offering medical, surgical, and intensive care services. In addition, a wide variety of outpatient services are available, including cardiac and physical rehabilitation; a fully-staffed oncology department; 24-hour emergency care; a fully equipped laboratory; and an extensive radiology department. Weeks is blessed with strong leadership and a dedicated community that allows us to meet the ever-changing requirements of today’s healthcare environment.

About North Country Healthcare (NHC):

North Country Healthcare is a non-profit affiliation of four medical facilities, Androscoggin Valley Hospital, North Country Home Health & Hospice Agency, Upper Connecticut Valley Hospital, and Weeks Medical Center, located in the White Mountains Region of New Hampshire. NCH includes numerous physicians and medical providers at multiple locations. This leading comprehensive healthcare network which employs hundreds of highly-trained individuals delivers integrated patient care through three community hospitals, specialty clinics, and home health and hospice services. NCH remains committed to the health and well-being of the communities we serve.

North Country Healthcare is an equal-opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

If you require a reasonable accommodation in completing this application, interviewing, completing any pre-employment testing, or otherwise participating in the employee selection process, please direct your inquiries to the Human Resources department at the affiliate to which you are applying.

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