Join to apply for the RN Care Coordinator-Indiana role at Eventus WholeHealth
Responsibilities
Coordinate care management in collaboration with the Mid-Level Practitioner (MLP).
Ensure ICT meetings occur regularly and include the MLP, Provider Physician, RNCC, SNF staff, administrators, beneficiaries, and families.
Complete Health Risk Assessment within 30 days of enrollment for all new attributed members and update the HRA within 364 days of the initial assessment.
Triage care needs based on member’s HRA scores and information from other sources.
Educate skilled nursing facilities’ staff through ICT meetings and regular communications while onsite.
Provide in‑service education to skilled nursing facilities’ staff on geriatric needs such as polypharmacy, fall prevention, and wound‑care management.
Identify and address changes in member’s health status by being available on call when not at the skilled nursing facility during scheduled visits.
Participate in quality assurance initiatives to develop and implement best practices.
Advocate, inform, and educate members and their families through regular meetings and discussions.
Maintain accurate and up‑to‑date documentation in the electronic health record regarding assessments, care plans, progress notes, and communications with family and patients.
Participate in meetings to discuss quality metric goals and progress toward those goals.
Develop a plan of care for each member in collaboration with the ICT team.
Authorize and facilitate access to all covered services.
Provide clinical care to members to evaluate progress, conduct physical exams, prescribe interventions, and communicate results to the SNF staff and other attending physicians or practitioners.
Oversee transitions of care with communication from hospital, provider, family, and skilled nursing facility.
Conduct follow‑up assessments and ensure continuity of care post‑discharge from hospital.
Obtain labs, diagnostic reports, and consultation reports and review as needed with the medical director and ICT.
Provide information and document decisions regarding Advance Directives.
Qualifications
Registered Nurse skills and qualifications.
2+ years’ experience in a LTC/ALF setting.
Computer skills and proficiency in MS Office, PCC, and Matrix.
Experience in care coordination or case management (plus).
Effective verbal and written communication skills.
Highly organized with confidential client material, appointment tracking, and caseload management.
Strong customer service skills and knowledge of geriatric population and patient navigation.
Ability to work independently, meet deadlines, and handle multiple priorities efficiently.
Ability to solve problems with minimal direction.
Attention to detail and accuracy.
Interest in working with geriatric clients.
Knowledge of chronic conditions and medications.
Seniority Level
Entry level
Employment Type
Full‑time
Job Function
Health Care Provider
Industries
Hospitals and Health Care
Referrals increase your chances of interviewing at Eventus WholeHealth by 2x