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Registered Nurse Chronic Heart Failure Care Coordinator
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Part-time
- We're a non-profit organization with a clear vision of being the leader in transforming rural health care by achieving the highest levels of quality, access, and value.
- The RN Clinic/CHF Care Coordinator will work under the supervision of the Clinic Nursing Leadership team and focus on the social determinants of health, serve as an available resource advocating for patients, work collaboratively with the providers to manage population health, and provide education and support to the clinical teams.
- Coordinates services and support patients through care transitions such as home, hospital in-patient, nursing home, assisted living, and adult foster care for continuity of care and patient safety.
- Completes Transitional Care Management (TCM) calls from hospital discharges and provide chronic care management services.
- Knows the key staff available to help patients with financial and emotional support; arranges for patients to meet with these resource people if needed.
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