RN Care Coordinator -AMG Connections Center - P/T

Augusta Health Careers•Fishersville, VA

About The Position

The RN Care Coordinator provides advanced care coordination in an ambulatory setting, using independent nursing judgment for triage, clinical decision-making, management of patient needs, and guidance through the health system. The role is a central clinical resource for triage, provider inbox and clinical result management, medication oversight, and the creation and implementation of clinical pathways, policies, and services. It manages RN-level clinical tasks that support safe, efficient care and help providers practice at the top of their license. The RN Care Coordinator acts as a patient advocate and liaison among patients, families, providers, and clinical teams, promoting access, education, timely care, and continuity while practicing with a high level of autonomy within established protocols. The role provides comprehensive clinical triage, manages assigned provider inboxes and clinical result queues, coordinates medication and prescription matters, orders routine laboratory testing and imaging under protocols, and manages referrals requiring RN clinical assessment. It also collaborates with the care team on patient access, education, quality, and safe workflows, and ensures accurate and timely electronic health record documentation. The position is part-time. Augusta Health describes itself as a mission-driven, independent, nonprofit community health system in Fishersville, Virginia, offering inpatient and outpatient services through Augusta Medical Center and Augusta Medical Group.

Requirements

Bachelor's degree in Nursing.
Current and valid Registered Nurse license in the Commonwealth of Virginia or a license from a state participating in a Compact agreement with Virginia.
CPR certification.
Previous computer experience, including electronic health records and database applications.

Nice To Haves

Ambulatory Care Nursing Certification (AMB-BC).
Previous ambulatory office experience.

Responsibilities

Perform RN-level clinical triage for patient calls, walk-in encounters, electronic messages, abnormal test results, and referrals using evidence-based protocols, standing orders, and independent nursing judgment.
Assess symptoms, vital sign trends, acuity, comorbidities, and risk factors to determine appropriate care disposition and escalate urgent or emergency needs.
Coordinate same-day or expedited provider care and follow-up for high-risk patients when appointments are unavailable.
Provide patient education, clinical guidance, and safety instructions within RN scope, adapting communication to health literacy, cognitive ability, and social circumstances and using teach-back when appropriate.
Coordinate transitions of care after emergency department visits, hospitalizations, procedures, or diagnostic testing, including follow-up planning, medication reconciliation, and education.
Manage assigned provider inboxes, clinical result queues, and communication buckets; assess and prioritize time-sensitive and high-risk items.
Resolve inbox items within RN scope using approved protocols and standing orders, including outreach, education, monitoring plans, and follow-up scheduling; escalate complex or out-of-scope issues to providers.
Communicate abnormal laboratory and imaging results, provider recommendations, diagnosis and lifestyle education, medication guidance, and plans for repeat testing or follow-up.
Ensure closed-loop communication, timely documentation, and follow-up for clinical results.
Review prescription refill requests, verify the prescribing provider and follow-up intervals, assess medication safety, and identify interactions, contraindications, side effects, adherence concerns, and polypharmacy risks.
Educate patients and families on medication administration, dosing, side effects, and precautions; provide hands-on education for newly initiated insulin therapy and assist with CGM setup and education.
Make RN-directed medication decisions when clinically indicated in collaboration with providers; instruct patients to track and report blood pressure, heart rate, and blood glucose and assess trends.
Coordinate with pharmacies and insurers to resolve prescription issues, including signature clarification, quantity adjustments, refill authorization, and covered therapeutic substitutions.
Order routine laboratory testing and preventive imaging under standing orders and protocols; communicate results and coordinate follow-up, referrals, and repeat testing as needed.
Apply appropriate diagnosis codes for laboratory testing, imaging, and referrals to support insurance coverage and reduce barriers to care.
Place, manage, and track internal and external referrals requiring RN assessment; evaluate appropriateness and collaborate with providers on clarification or urgency.
Partner with navigators and support staff to support timely scheduling, completion of prerequisites, and referral follow-through.
Collaborate with providers, nursing staff, navigators, and front office staff to support safe, efficient, patient-centered workflows and optimize clinic access.
Provide emotional support to patients and families using a holistic, trauma-informed approach.
Audit EKGs across primary care and multispecialty clinics to ensure appropriate follow-up and provider review.
Identify trends in access, safety, utilization, or quality and contribute to service-line improvement efforts.
Maintain accurate, timely, and compliant documentation in the electronic health record.