Care Coordinator - RN

Cottage Hospital•Woodsville, NH

3d•Onsite

About The Position

Care Coordinator RN Rowe Health Center | Cottage Hospital Schedule: Tuesday–Friday | Outpatient Setting Position Overview Cottage Hospital is seeking a compassionate, organized, and clinically strong Registered Nurse Care Coordinator to join our Rowe Health Center team. This role is ideal for an RN who enjoys building long-term patient relationships, coordinating care across services, and helping patients navigate complex healthcare needs in an outpatient setting. In this position, you will work closely with patients, families, primary care providers, specialists, and community partners to ensure timely access to care and continuity across the healthcare continuum. Your work will focus on supporting high-risk and chronically ill patients , improving preventive care utilization, and reducing emergency department visits and hospital readmissions. This role blends care coordination with clinical responsibilities, including triage support, medication management, and prior authorizations—requiring strong clinical judgment, critical thinking, and a proactive, patient-centered approach.

Responsibilities

Partner with high-risk and chronically ill patients and their caregivers to develop and support individualized care plans
Coordinate care across primary care, specialty providers, hospital departments, and community resources
Support care transitions following hospital admissions, discharges, and emergency department visits
Conduct and support preventive services, including: Medicare Annual Wellness Visits Transitional Care Management (TCM) Chronic Care Management (CCM) Advance Care Planning
Promote patient education, self-management, and behavior-change strategies
Monitor patients with multiple co-morbidities or high risk for readmission and intervene proactively
Assist with telephone triage, performing initial assessments and determining urgency of care needs
Use clinical judgment to guide patients to the appropriate level of care (home care, clinic visit, urgent or emergent care)
Support medication management, including prior authorizations, denials, and appeals
Track, monitor, and assist with medication refill requests in collaboration with providers
Maintain clear, consistent communication across the care team to ensure alignment on patient care plans
Document all patient interactions accurately and in a timely manner within the electronic medical record
Support overall clinic operations and patient care needs as required