RN CARE COORDINATOR

Covenant Health•Knoxville, TN

30d

About The Position

The RN Care Coordinator functions as a liaison among patients, physicians, and community referral sources to help manage and improve patients’ health. The role educates patients and families and coordinates additional services as needed. Working with the Care Management Team and under the direction of Quality Leadership, the RN Care Coordinator provides collaborative care management services and guidance to team members. This position supports outreach, quality reporting, performance measurement, care coordination, and continuity of care for patients with chronic conditions. It works with patients, providers, clinic staff, and insurance payors to support treatment plans, preventive care, evidence-based practice, quality initiatives, and effective care transitions.

Requirements

Active RN license in the state of Tennessee.
Three to five years of experience in a clinical setting.
Computer literacy and basic knowledge of Microsoft Office programs.
Ability to build rapport and engage patients in effective dialogue about their treatment plans.
Ability to quickly identify and prioritize patient needs and provide structured, focused support and interventions.
Strong critical-thinking, analytical, and creative problem-solving skills.
Strong independence, organization, and interpersonal skills.
Strong communication skills.

Nice To Haves

Case management experience is preferred.

Responsibilities

Provide guidance and supervision to Care Navigators to support a collaborative approach to care management.
Carry out patient outreach, quality reporting, performance measurement, and liaison functions between physicians and patients.
Conduct outreach to eligible patients identified as having chronic conditions.
Assess, identify, and prioritize individual patient needs, and build rapport and trust.
Review available member data, including clinical history, outpatient and inpatient treatments, emergency room visits, medications, and chart information, to support monitoring and adherence to prescribed care plans.
Collaborate with patients and providers to identify opportunities to optimize care and close care gaps.
Help patients understand physicians’ treatment plans, including prescriptions and refills, medical supplies, referrals, service authorizations, and when to seek care.
Assess patients and/or families to understand social, emotional, functional, and physical health status.
Promote patient education by providing informational materials and directing patients to appropriate community agencies and facilities.
Assist, educate, and facilitate the overall plan of care for patients with chronic conditions.
Liaise between practices and insurance payors regarding care and treatment options for patients with chronic health conditions.
Support preventive care for chronic patients, including screenings, lifestyle coaching, and ongoing follow-up.
Educate providers, office managers, and clinic staff about quality initiatives and clinical documentation improvement.
Maintain continuity of care among care coordination team members by documenting and communicating actions, opportunities, and ongoing needs.
Ensure evidence-based practice guidelines are incorporated into patient care plans.
Assist with coordinating care transitions for designated patient populations.
Monitor care processes to support cost-effective implementation and evaluation of utilization management and patient care initiatives.
Communicate effectively with payer care coordination teams to collaborate on patient care initiatives and management strategies.
Develop and use strategies to reduce unnecessary emergency room utilization and hospital readmissions.
Review and analyze available quality data to prioritize patient goals and develop care management strategies for appropriate populations.
Demonstrate knowledge of payer contracts, required quality metrics, and payer resources that support care coordination.
Understand HEDIS, HCCs, and Medicare Risk Adjustment and their impact on pay-per-performance contracts.
Perform other duties as assigned or requested.