Nurse Care Coordinator - North Charleston, SC

About the role

Quality Healthcare Development is seeking a Nurse Care Coordinator responsible for developing and implementing a comprehensive care coordination program in partnership with the Quality Director. This role focuses on engaging and supporting patients within the Accountable Care Organization (ACO) population to improve care quality, enhance patient outcomes, and reduce the overall cost of care. The Nurse Care Coordinator works closely with patients, families, providers, and the healthcare team to coordinate services and resources across the continuum of care. This role promotes patient engagement, self-management, and shared decision-making while improving health literacy for patients and caregivers. The position also serves as a liaison between patients, providers, and community resources to ensure coordinated, efficient, and patient-centered care.

Location: Charleston, SC. Employment Type: Full-Time. Reports To: Quality Director.

Responsibilities

• Care Coordination Program Development
  • Participate in program development, evaluation, and improvement initiatives.
• Patient Care Coordination
  • Perform key functions related to the success of the Care Coordination Program including patient outreach via telephone and occasional office encounters.
  • Maintain regular communication with patients in the assigned caseload.
  • Coordinate patient activities and ensure appropriate utilization of healthcare services.
  • Support care gap closure and ensure appropriate follow-up care.
• Patient and Family Engagement
  • Include patients’ family members, caregivers, and support systems in care coordination activities when appropriate.
  • Promote patient engagement, self-management, and shared decision-making.
  • Ensure patients and caregivers understand condition management, medications, tests, referrals, and recommended services.
• Care Planning and Collaboration
  • Work collaboratively with patients, providers, and healthcare teams to develop care plans that maximize health outcomes and cost-effective care.
  • Consult with providers and healthcare team members to address care issues and barriers to treatment.
• Care Transitions and Resource Coordination
  • Coordinate care across the continuum including post-discharge follow-up calls for hospitalized patients.
  • Assist patients in accessing community resources and financial assistance when appropriate.
  • Identify and address barriers to treatment plan adherence.
• Patient Education and Health Literacy
  • Utilize motivational interviewing and other strategies to promote patient engagement and improved health outcomes.
  • Assess and implement strategies to improve patient and caregiver health literacy.
  • Provide education and resources necessary to