Registered Nurse Care Coordinator, PRN (23557)

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
• 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

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.