RN/ Care Coordinator

Fairview Health Services•Minneapolis, MN

About The Position

The RN/Care Coordinator focuses on a specific medical specialty or chronic care condition and serves as a resource and educator to patients, medical staff, and hospital staff. The role coordinates safe, effective, efficient, and patient-centered transitions across the health continuum and provides proactive disease management using evidence-based practices. It also acts as a liaison among patients and families, medical staff, and others involved in treatment, supporting care based on jointly determined goals and priorities. The M Health Fairview Comprehensive Gender Care Program brings together specialists from across the system to provide coordinated care for transgender, non-binary, and gender-diverse patients. Its interdisciplinary team includes primary care providers, mental health specialists, and gender-affirming surgeons. The position provides specialty-area direct patient care, education, counseling, medication management, and care coordination. It may also support research, program promotion, policy development, and outcome tracking. The posted pay range applies to a 40-hour workweek (1.0 FTE); actual pay depends on factors including FTE, skills, knowledge, education, experience, market conditions, and internal equity.

Requirements

At least 3 years of specialty experience in care coordination, or 5 years as a licensed RN with 5 years of clinical experience and the ability to learn a new specialty area.
Minnesota Registered Nurse (RN) license.
Basic Life Support certification from the American Heart Association or Red Cross; this requirement does not apply to department 8901 Ambulatory Care Coordination within 30 days.

Nice To Haves

Licensed RN with a four-year baccalaureate degree.
2 years of RN experience in the specialty area or previous care coordination experience.
Specialized knowledge of the specialty and conditions of the population served.

Responsibilities

Accesses, analyzes, plans, and provides follow-up care.
Facilitates timely referrals and fosters positive relationships with community providers.
Evaluates and documents patient status and progress through phone calls, test results, and report preparation; evaluates nursing-care quality through patient rounds.
Identifies problems specific to the clinical specialty.
Provides proactive disease management using evidence-based practices.
Acts as a liaison among patients and families, medical staff, and others involved in treatment, promoting patient-centered care based on jointly determined goals and priorities.
Collaborates with appropriate staff to coordinate transitions of care across the healthcare continuum.
Provides direct patient care in the specialty area and establishes individual nursing care plans.
Provides education, counseling, medication management, and general health information to patients and their representatives.
Triages patient concerns and responds between visits under provider direction to reduce relapse or inpatient care.
Serves as a specialty resource to patient care units, outpatient clinics, and medical staff.
Identifies needs and assists with writing and implementing policies and procedures.
Provides specialty education to patients, families, and hospital staff; develops content and resource materials and coordinates the education plan.
Serves on task forces and committees related to the specialty.
Keeps current on technological advances and new pharmaceutical products.
Consults with other areas regarding the specialty.
Assists with research projects, including data collection, analysis, and evaluation, and may identify research projects.
Manages databases to track patient outcomes and other specified categories as directed by a physician.
Promotes the program and assists with marketing efforts; oversees or manages prior authorization and results verification processes.
Provides effective educational materials and serves as a community liaison.
Performs other duties, including performance goals developed by the manager and employee and reported in the employee’s performance review.
Develops and maintains critical competencies listed in the job description and the employee’s online performance management tool.