Ambulatory RN Care Coordinator

Cleveland Clinic•Cleveland Clinic Nevada, NV

4d•Hybrid

About The Position

At Cleveland Clinic Lou Ruvo Center for Brain Health, our caregivers are dedicated to helping patients cope with and manage the effects of memory loss. Come join us in our efforts to provide effective, evidence-based treatment with the latest technologies and approaches. Here, you will make a difference in the community, gain unmatched hands-on experience, enhance your skills and build a rewarding, life-long career at one of the most respected healthcare organizations in the world. As a Care Coordinator, you will work collaboratively with multidisciplinary care team staff across the continuum of care for high-risk patients. In this role, you will provide coordination of care and disease management longitudinally for patients with chronic conditions or episodic care for a surgical population. You will focus on patient outreach and care coordination for a panel of patients to achieve optimal outcomes and promote wellness, helping to decrease preventable emergency department visits and readmissions while improving patient satisfaction.

Requirements

Graduate from an accredited school of Professional Nursing
Current state licensure as a Registered Nurse (RN)
Basic Life Support (BLS) certification through the American Heart Association (AHA) or American Red Cross
Three to five years of nursing experience

Nice To Haves

Bachelor’s of Science in Nursing (BSN) within three years from hire date
Specialty certification
Epic EMR experience
Case management or care coordination experience
Neurological background

Responsibilities

Work collaboratively with a multidisciplinary care team across the continuum of care for high-risk patients to develop goals, plan interventions and maximize patient outcomes.
Provide care and disease management coordination.
Identify patients in the specialty care practice that have ongoing coordination needs and conduct targeted outreach.
Conduct comprehensive clinical assessments that include disease/age-specific, medical, behavioral, pharmacy, social and end of life needs of each patient.
Inform and work with patients and their families regarding coordination of their care, provide education and coaching, monitor patient compliance with their care plan, perform reassessments regarding patient progress toward goals, and update plan of care.
Serve as a liaison and advocate for patients and families.
Assist in managing transitions of care across care settings, ensuring optimal communication and planning.
Identify barriers, facilitate solutions, and connect others to community resources.