WI3644560

1

Unspecified

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JOB REQUIREMENTS: Kenosha Community Health Center and Pillar Health is
looking for Registered Nurse Care Coordinators to support its many
primary care providers across multiple locations. \$5,000 hiring bonus -
See below for details. POSITION SUMMARY The Registered Nurse Care
Coordinator (RNCC) has a vital role within the KCHC/Pillar Health
integrated care model. As a key partner to an assigned care provider(s)
they support management of a patient panel using proactive and planned
care goals while also coordinating the care team necessary to achieve
them. The RNCC participates in the delivery of evidence-based care to an
assigned patient population utilizing defined care standards,
identifying care gaps, ensuring efficient access to care, care planning,
and facilitating seamless care transitions and care continuity. The RNCC
also participates in the analysis of outcomes, identification of
opportunities for improvement, and implementation of changes to optimize
outcomes for individual patients and the overall population. The
position of the RNCC in the care model places the role in a unique
position to facilitate an interprofessional team of clinicians in a
wraparound care coordination model that will identify and address
patient emergent, chronic, preventative care and social needs placing
place patients in the best position for optimal health outcomes.
ESSENTIAL FUNCTIONS The list of duties and responsibilities is not all
inclusive and may be expanded to include other duties and
responsibilities, as management may deem necessary from time to time.
Coordination and Management of the Patient Panel Reviews and assesses
patient registration data, including outpatient or inpatient treatments,
emergency room visits, medications, chart reviews, to assist in the
monitoring and facilitation of adherence to prescribed care plans. Using
the Electronic Health Record (EHR) and other electronic resources to
identify patient care gaps and coordinate activities with the provider
and care team to close those gaps. Utilizes organization defined risk
stratification tools, EHR, and other electronic resources to risk
stratify the assigned patient panel and track indicators of the panel.
Chronic Care Management of medium, rising risk and high-risk patients
Draw conclusions from available data to develop an overall strategy for
the assigned patient panel as a whole, and individual patients in the
different risk groups. Routinely evaluates social needs that can
negatively impact health outcomes. Connects patients to available
resources to meet those needs. Initiates or contributes to the
development and implementation of individualized, comprehensive care
plans including medical and social\... For full info follow application
link. Kenosha Community Health Center is an Equal Opportunity employer.
All qualified applicants will receive consideration for employment
without regard to race, color, religion, sex, national origin,
disability or veteran status. \*\*\*\*\* APPLICATION INSTRUCTIONS: Apply
Online: ipc.us/t/A154679AB463405F