Registered Nurse Care Coordination Primary Care

Mount Nittany Health • Bellefonte, PA

6d

About The Position

Serves in an expanded nursing role as part of an interdisciplinary team, delivering comprehensive care coordination, patient education, and nursing support across the primary care continuum. Responsibilities include triaging clinical concerns, supporting chronic disease management, and facilitating smooth care transitions through phone, patient portal, and in-person interactions. This RN assesses patient needs to determine the appropriate level of care and ensures timely access to services and resources. This role is central to care team communication, patient advocacy, and alignment with evidence-based practices. Additionally, the RN performs Medicare Annual Wellness Visits in collaboration with providers, supporting preventive health efforts and individualized care planning.

Requirements

• Completion of an accredited registered nurse program required.
• Licensed as a Registered Nurse in the State of Pennsylvania.
• Meets the American Heart Association’s standards for Healthcare Provider Basic Life Support (BLS) and renews BLS every two years.
• High self-initiative with the ability to work well under pressure and with minimal supervision.
• Conducts business in a professional and cordial manner that upholds the integrity and reputation of Mount Nittany Health System.
• Strong critical thinking skills with the ability to prioritize patient needs and make sound decisions.
• Communicates effectively and collaboratively with patients, families, and interdisciplinary teams.
• Highly organized and uses time efficiently and effectively.

Nice To Haves

• Two years’ experience working in a physician group practice preferred.

Responsibilities

• Triaging clinical concerns
• Supporting chronic disease management
• Facilitating smooth care transitions through phone, patient portal, and in-person interactions
• Assessing patient needs to determine the appropriate level of care
• Ensuring timely access to services and resources
• Care team communication
• Patient advocacy
• Alignment with evidence-based practices
• Performing Medicare Annual Wellness Visits in collaboration with providers
• Supporting preventive health efforts and individualized care planning

What This Job Offers

• Job Type: Full-time
• Education Level: No Education Listed
• Number of Employees: 1,001-5,000 employees