Acute Care, Case Management, Clinical Assessment, Clinical Data Collection, Communication Skills, Contact Management, Documentation Plan, English Language, Establish Priorities, Facilities Planning, Health Plan, Hospice Care, Hospital, Leadership, Lift/Move 50 Pounds, Long-Term Care, Managed Care, Medicare, Needs Assessment, Nurse Practitioner, Organizational Skills, Physical Demands, Primary Care, Professional License, Registered Nurse (RN), Risk, Risk Analysis, Risk Management, Special Needs, Team Player, Telephone Technology, Time Management
Title: Registered Nurse Care Coordinator
Reports to: VP of Advanced Primary Care Practice
What We Offer You
- Competitive pay
- Comprehensive health, dental, and vision coverage
- Supplemental benefits (life insurance, disability, accident, etc.)
- 401(k) with company match
- Generous paid time off (Vacation/Sick/Holiday) for full‑time positions
- Career growth and advancement opportunities
- A company culture committed to compassionate, coordinated care
- Many more perks and benefits
Job Summary
The Registered Nurse Care Coordinator (RNCC) partners with the ProCare Advantage Institutional Special Needs Plan (ISNP) Nurse Practitioner (Plan NP) to coordinate care for ISNP Beneficiaries (Plan Members). The RNCC maintains routine contact with Plan Members, families, and facility staff, monitors changes in condition, and ensures timely communication with Plan NPs and interdisciplinary care teams. This role plays a critical part in supporting proactive care management, reducing unnecessary transitions, and improving outcomes for high‑acuity long‑term care residents.
Qualifications
- Active Registered Nurse (RN) license in the respective state
- Compliance with all required State and Federal guidelines
- Must maintain ongoing Texas Board of Nursing educational requirements for licensure and re‑certification
- Strong communication and coordination skills
- Ability to work collaboratively with interdisciplinary teams and facility leadership
Essential Functions
- Assist the Plan NP with care coordination duties and documentation for Plan Members
- Initiate and complete assessments, including vital signs and other clinical data collection
- Perform daily rounds to identify medical, emotional, or behavioral changes in Plan Members
- Obtain daily Plan Member census and report transitions (ED visits, hospitalizations, hospice elections, returns from hospital) to Plan NPs and RNPs
- Monitor Plan Members during transitions to and from the hospital; communicate updates to facility staff and Plan NPs
- Ensure Plan NP receives all discharge paperwork and summaries following hospital transitions
- Conduct timely in‑person follow‑ups after transitions to reduce readmission risk and identify additional needs
- Partner with facility staff and the Interdisciplinary Care Team (ICT) to implement care plans and coordinate specialty, therapy, or ancillary services
- Alert the Plan NP promptly of new enrollees and prioritize intervention for Plan Members at risk for transition
- Support proactive care management to improve outcomes and reduce unnecessary hospitalizations
- Perform other duties as assigned
Continuing Education
- Attend required in‑services and continuing education programs to maintain professional licensure and certification
- Participate in ongoing education related to Medicare and Managed Care Case Management
Physical Demands
- Ability to communicate in English via phone, in writing, and verbally with staff, residents, families, and external partners
- Ability to stand, walk, sit, reach, handle, or feel objects as needed
- Ability to drive a personal vehicle to multiple facility locations
- Ability to lift up to 50 pounds occasionally
- Ability to use a computer, phone, and related technology for extended periods
- Occasional exposure to facility environments, including noise, chemicals, and airborne particles
- Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions
We are an Equal Opportunity Employer. We offer an excellent benefit plan including 401(k) with match, CEU reimbursement, vacation, sick time, holidays, medical, dental, and supplemental insurance plans, as well as a highly competitive compensation package.
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Cantex Continuing Care Network LLC