Nurse Integrated Care Coordinator

Seven Counties Services•Louisville, KY

6d•Hybrid

About The Position

This role serves as the first point of clinic contact for new clients, explaining available services and focusing on client engagement. The position involves completing health screenings, nursing assessments, and triaging healthcare needs for both new and ongoing clients. The Nurse Integrated Care Coordinator participates in team meetings to develop client care plans, assists clients in navigating the healthcare system, and advocates on their behalf with providers and managed care organizations to ensure timely, quality care. This role also assists with accessing services that address social determinants of health, including providing transportation to appointments when needed, identifying other access barriers, and helping clients access community resources like public assistance and financial benefits. Collaboration with other healthcare providers in the service area is expected, as is providing education and support for wellness activities such as healthy eating, physical activity, and healthy behaviors. A key responsibility is assisting clients transitioning from inpatient treatment, incarceration, residential care, or Emergency Department visits to outpatient care, utilizing evidence-based transitional/navigation services to prevent readmissions. The role also involves collaborating with clients, family, and significant others to develop support networks. Incumbents may be asked to perform other related tasks as needed.

Requirements

Licensed Practical Nurse with current active license to practice in Kentucky.
Three years of nursing experience in a hospital, physician office, or behavioral care clinic.
Experience in community setting or integrated care environment.
Reliable transportation for frequent travel.

Responsibilities

Provides first point of clinic contact for all new clients.
Explains services available and focuses on engagement of client to access services.
Completes health screenings, nursing assessments and triage healthcare needs for new and ongoing clients.
Participates in team meeting to develop a plan of care to address client needs.
Assists clients in navigating the healthcare environment to ensure access to appropriate care.
Advocates on client’s behalf with healthcare providers and managed care organizations to ensure timely quality care.
Assists with coordination/access to services that address social determinants of healthcare outcomes.
Provides transportation to healthcare appointments, when needed.
Identifies other needs, when necessary, that ensure access to healthcare.
Assists with access to other community resources e.g., public assistance and financial benefits.
Develops knowledge base of other healthcare providers in the service area and collaborate, as needed.
Provides education and support wellness activities such as healthy eating, physical activity, and healthy behaviors.
Assists clients who have recently discharged from inpatient treatment, incarceration, residential care, and/or Emergency Department visits to ensure a transition to outpatient care using evidence-based transitional/navigation services to prevent readmissions.
Collaborates with client, family/significant others to develop support networks.