Nurse Care Coordination

CommonSpirit Health•Prescott, AZ

1d•Onsite

About The Position

Where You’ll Work Are you ready to join a healthcare family where your values align with ours? At Dignity Health – Yavapai Regional Medical Center (DH-YRMC), now a proud part of CommonSpirit Health, a not-for-profit integrated healthcare provider, our core mission guides every decision and every interaction. Here, you'll discover more than just a job; you'll find rewarding career opportunities across a comprehensive network of inpatient and outpatient services. From a vibrant community hospital, YRMC has grown into a leading regional healthcare system. Today, that means you could be making an impact at: Two state-of-the-art acute care hospitals A robust network of primary and specialty care clinics Modern outpatient health and wellness services Acclaimed cardiac diagnostic centers Advanced outpatient medical imaging facilities Elevate your career without sacrificing your quality of life. As you grow with YRMC, you'll find the Prescott area isn't just a place to work – it's an inspiring community designed for living, thriving, and embracing the outdoors. Imagine a charming blend of bygone appeal and modern amenities, coupled with four distinct seasons and nearly year-round sunshine perfect for every adventure. Say hello to a relaxed lifestyle that empowers you to prioritize both your professional growth and family time. YRMC extends this inviting spirit within our walls, fostering a strong sense of family, and belonging among our team members. Come experience the exceptional quality of life that YRMC and Prescott offer. Work at the heart of #hellohumankindness and discover where your career and well-being truly connect.

Requirements

Minimum Two (2) years of acute hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1 year experience
Graduate of an accredited school of nursing
Registered Nurse: AZ or Compact license
American Heart Association BLS required within 90 days
Knowledge of managed care and payer environment
Must have critical thinking and problem-solving skills
Collaborate effectively with multiple stakeholders
Understand how utilization management and case management programs integrate
Ability to work as a team player and assist other members of the team where needed
Knowledge of CMS standards and requirements

Nice To Haves

Bachelor's Degree in Nursing (BSN) or related healthcare field
At least five (5) years of nursing experience
Certified Case Manager (CCM) or Accredited Case Manager (ACM-RN)

Responsibilities

Lead comprehensive care progression and discharge planning for diverse inpatient population (birth to adult).
Orchestrate the delivery of healthcare and social services, balancing patient/family needs with cost-effective resources.
Advocate for patients, addressing complex factors like spiritual needs and socioeconomic barriers, and ensuring seamless, equitable transitions of care.
Meticulously conduct and update discharge planning assessments, facilitating multidisciplinary collaboration for timely and smooth transitions to post-acute care settings.
Oversee implementation of discharge plans, optimize inpatient resource utilization, identify and mitigate readmission risks, and provide essential patient education and advocacy, all while adhering to hospital policies and promoting cost-effective, quality outcomes.
Completes and documents a discharge planning assessment on those patients identified by the designated screening process, or upon request.
Reassess the patient as appropriate and update the plan accordingly.
Facilitates the development of a multidisciplinary discharge plan, engaging other relevant health team members, the patient and/or patient representative and post acute care providers in accordance with the patients clinical or psychosocial needs, choices and available resources.
Oversees and evaluates the implementation of the discharge plan.
Collaborates with the multidisciplinary team to ensure progression of care and appropriate utilization of inpatient resources using established evidence based guidelines/criteria.
Collaborates with the healthcare team and post-acute service providers to ensure timely and smooth transitions to the most appropriate type and setting of post-acute services based upon patients clinical needs.