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The Population Health Care Coordinator RN uses the nursing process to provide patient- and family-centered care that respects each person’s uniqueness and addresses physical, psychological, emotional, and social needs. As part of the ambulatory clinical team, the nurse collaborates, communicates, and coordinates care across settings—including the home, physician office, hospital, and skilled nursing facility—with primary care providers, support systems, and other care team members. The role supports cost-effective, high-quality care and develops and implements individualized plans based on each patient’s circumstances and environment. The approach is patient-centric and intended to improve health and care experience while managing costs for an identified patient population. The nurse coordinates transitions, referrals, report management, and communication among primary care providers, specialists, and other providers. The role includes timely follow-up after hospital discharge and emergency department visits, management of complex and high-risk patients, ongoing communication with providers and practice teams, and coordination with other care managers and specialists.
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Job Type
Full-time
Career Level
Senior
Education Level
No Education Listed

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