Care Coordination Nurse Manager

VNACJ Community Health Center•Monmouth County, NJ

16h

About The Position

The Care Coordination Nurse Manager oversees care coordination and case management programs at Visiting Nurse Association of Central Jersey Community Health Center. The role manages functions required by the HRSA Health Center Program, including referral coordination, post-hospitalization tracking, and value-based care initiatives. The manager leads a team, strengthens clinical workflows, and helps ensure patients receive coordinated care across the healthcare continuum. The position combines team leadership, clinical and operational improvement, patient-centered care, community partnership development, and quality and compliance work. It includes analyzing EHR workflows and population-level data, reporting performance metrics to senior leadership, supporting transitions of care for at-risk populations, and preparing for HRSA Operational Site Visits and clinical audits. The work is performed indoors in a fast-paced outpatient ambulatory care environment in Monmouth County, New Jersey.

Requirements

Registered Nurse (RN) required.
Experience in population health or care coordination.
3–5+ years of clinical nursing experience.
Strong computer proficiency, including advanced Excel and data analysis.
Excellent written and verbal communication skills.
Experience with statistical analysis, report interpretation, and quality improvement.
Knowledge of community health and social service networks.
Strong interpersonal skills and the ability to work effectively across diverse teams.
Valid New Jersey driver’s license and reliable transportation.

Nice To Haves

Bachelor of Science in Nursing (BSN).
Clinical nursing experience in ambulatory or community health.

Responsibilities

Provide daily leadership and oversight for the Patient Care Coordinator team.
Ensure adequate team coverage, efficient workflows, and adherence to organizational policies.
Foster a positive, collaborative, and mission-aligned work environment.
Analyze and refine clinical and EHR workflows to improve patient outcomes.
Collaborate with the Medical Director and Clinical Support teams to implement standardized processes.
Track and report performance metrics, including monthly dashboards and UDS measures, to senior leadership.
Identify unmet patient needs using evidence-based guidelines and ensure the care coordination team engages patients in shared decision-making.
Support continuity of care by tracking referrals and monitoring hospital and emergency room utilization.
Build relationships with hospitals, specialists, and community organizations.
Connect patients with appropriate community resources and support seamless transitions of care for at-risk populations.
Use the EHR to manage population-level data and generate reports.
Participate in committees and develop data-driven reports and corrective action plans.
Support preparation for HRSA Operational Site Visits and clinical audits.