Medical - RN Care Partner

Marana Health•Marana, AZ

21h•$69,451 - $95,493•Onsite

About The Position

Marana Health is seeking an RN Care Partner to join the Medical team at the Marana Main Health Center in Marana, Arizona. The role provides clinical care coordination and patient support to improve outcomes, continuity of care, and access to healthcare. Working collaboratively with the clinical team, the RN Care Partner supports chronic disease management, hospital follow-up, preventive care, patient education, and transitions of care. The position promotes patient-centered care while supporting organizational quality, access, and population health goals. Marana Health is a Federally Qualified Community Health Center with 11 sites in Tucson and Pima County. Its mission is to improve the community by providing exceptional, whole-person healthcare. The position does not direct or supervise others.

Requirements

Associate degree in Nursing.
Valid Arizona Registered Nurse license.
Two years of nursing experience.
Basic Life Support (BLS) certification.
Fingerprint Clearance Card through the Arizona Department of Public Safety.
Knowledge of nursing principles, care coordination, and patient-care techniques for neonates, infants, children, adolescents, adults, and geriatric patients.
Competence in patient triage in a primary care setting, with strong assessment, critical-thinking, and clinical decision-making skills.
Knowledge of quality metrics, population health, and value-based care principles.
Computer proficiency, including Microsoft Office applications.
Knowledge of patient appointment scheduling.
Excellent customer service, organizational, and communication skills, with an emphasis on responsiveness, building trust, mutual respect, and courtesy.
Cultural competence and effective communication and interpersonal skills with diverse patient populations.

Nice To Haves

Bachelor’s degree in Nursing.
Case management experience.
Bilingual in English and Spanish.
Certified Diabetes Educator (CDE from NCBDE) or Board Certified-Advanced Diabetes Management (BC-ADM from AADE) credential.
An equivalent combination of education and experience may be considered if applicable and directly related to the functions and knowledge required to perform the job.

Responsibilities

Coordinate patient care activities across the continuum of care.
Collaborate with clinicians and interdisciplinary staff, both internal and external, to identify and resolve concerns.
Provide telephonic and in-person patient outreach, education, and follow-up.
Provide counseling and coordinate treatment plans for patients.
Identify and address barriers and assist patients in accessing resources to achieve their personal health goals.
Support hospital discharge follow-up, emergency department follow-up, and transition-of-care management.
Monitor and manage high-risk patient populations to improve quality outcomes and reduce avoidable utilization.
Engage with patients and families to determine and facilitate the level of case management support required.
Conduct patient telephone and in-person triage to help determine the appropriate level of care.
Administer injectable medications to medical and behavioral health patients according to clinician orders.
Perform wound care according to clinician orders.
Guide transitions of care to achieve individualized patient and family quality outcomes.
Evaluate and monitor care-plan effectiveness and initiate necessary changes.
Serve as a patient advocate and liaison among the patient, family, and healthcare team.
Document care plans and interventions.
Coordinate patient-centered care to facilitate comprehensive health promotion and chronic-condition care.
Provide ongoing, proactive, planned care interventions to support illness management and relapse prevention.
Support the primary caregiver within the family.
Participate in team huddles, case conferences, and interdisciplinary meetings as assigned.
Provide developmentally appropriate preventive guidance and referrals.
Support primary care and subspecialty co-management through timely communication, inquiry, follow-up, and integration of information into the care plan.
Serve as a medical-home quality-improvement team consultant, assisting with quality measurement and identifying, assessing, refining, and implementing practice improvements for patient-centered care.
Provide patient care according to clinicians’ standing orders.
Schedule appointments with patients and families as needed to assess care plans and coordinate services within, between, and outside Marana Health.