RN Care Coordinator- Comprehensive Care Clinic

DescriptionCoordinated Care that Changes Lives.What We're Looking For:A compassionate, detail-oriented nursing professional skilled in coordinating patient care across assessment, planning, implementation, and evaluation.Strong ability to collaborate with patients, families, physicians, and interdisciplinary teams.Excellent clinical judgment, communication skills, and ability to manage complex care processes.Experience requirements:5 years of nursing experience2 years of experience in case/disease management, quality improvement, or community health.Preferred experience in care management, discharge planning, and home health.Educational & Licensing Requirements:Current Louisiana RN licensure.Special Skills & Knowledge:Ability to organize and prioritize for optimal results.Strong analytical and problem-solving abilities.Experience writing policies/procedures, project management, and workflow design preferred. Why You'll Love Working With Us:At Baton Rouge General, our commitment goes beyond caring for patients-we care for our people. We support our team with resources that enhance professional development, work-life balance, and overall well-being.Comprehensive benefits for you and your family.Ongoing professional development and growth opportunities.Employee perks including generous PTO, flexible roles, and participation in BRG Fit!.Nationally recognized for high-quality care.Explore our perks here: Perks - Baton Rouge General What You Will Do:Job Purpose / Mission:To improve the quality of life of patients and families by coordinating the care process-including assessment, planning, implementation, and evaluation-in collaboration with the patient, family, physician, and appropriate support services for the population served.Essential Job Functions:1. Coordinate Patient AssessmentCollect and prioritize patient health data based on condition and needs.Involve patients, families, and care providers as appropriate.Use evidence-based guidelines to coordinate care.Serve as liaison between patients/families and physicians, specialty providers, hospital staff, and health plans.Identify and coordinate needs requiring interdisciplinary assessment. 2. Analyze Assessments to Determine Nursing Diagnoses & OutcomesIdentify expected patient outcomes aligned with goals.Demonstrate proficiency across all age groups.Integrate Gaps in Care, predictive modeling, and data reports into provider workflows.Generate preventive service reminders for patients not meeting age/gender guidelines. 3. Identify & Implement Patient InterventionsUse interventions consistent with individualized plans of care.Protect and uphold patient rights.Provide tailored education to patients and families.Collaborate on discharge planning.Document assessments and teaching thoroughly. 4. Evaluate Patient ProgressPerform systematic reassessments, adjusting the plan of care as needed.Involve patients, families, and the care team in care-plan updates.Evaluate effectiveness of treatments, medications, and education.Support patient self-management and identify barriers to compliance.Coordinate follow-up after inpatient or outpatient services.Address risks for medication non-compliance and promote participation in disease management programs. 5. Coordinate Clinical & Financial Resource UtilizationPerform clinical and discharge assessments on all assigned patients.Initiate and update discharge plans with all relevant healthcare professionals.Coordinate referrals to post-acute providers.Refer complex cases to leadership and medical directors.Maximize BRG reimbursement through accurate documentation and payer communication.Promote efficient resource utilization and use preferred vendors. 6. Participate in Quality ImprovementReport sentinel events and care-quality concerns within 24 hours.Collect and report data on avoidable days.Engage in performance improvement teams as needed. What Sets BRG Apart:At Baton Rouge General, we are a community of dedicated professionals committed to delivering exceptional healthcare. Our mission is to preserve and restore health-one person at a time.With more than 600 licensed beds across three campuses, we provide comprehensive care across the continuum-from maternity to hospice-and offer extensive specialty services through our regional clinic network.