- Monday through Friday, hours vary and some weekends/evenings may be required
If you are an RN with at least 2 years of experience and are interested in helping to develop a new program dedicated to patients with diabetes, we would like to talk with you. The ideal candidate will have a demonstrated ability to support patients with diabetes as they develop self-management skills, excellent communication and teaching skills, the interpersonal skill to work collaboratively with diverse clinical teams, and experience in collaborating with community partners in the Central New York area. The successful candidate would join a team of healthcare professionals who are passionate about supporting patients as they learn to navigate the healthcare and community-based resource systems. The RN Care Coordinator for our Diabetes Center of Excellence will be a key resource for our clinical teams and patients.
- Conduct initial and ongoing assessments to determine patient care needs and develop targeted interventions.
- Initiate disease management care coordination protocols.
- Assist in developing and implementing population health initiatives.
- Determine and manage outcomes, ensure continuity of care through planning, utilization of resources and analysis of variances.
- Manage patients of moderate to high risk, including management of patients with multiple comorbidities or those at risk for high utilization rates.
- Support patient self-management of disease and behavior modification interventions using transitional care methodologies.
- Function as a contact person for patient, family, health care team members, community resources and employees as necessary.
- Facilitate communication with insurance companies, home care agencies, and community resources such as area agency on aging to connect patients to needed services.
- Facilitate medical necessity approvals, pre-certification as needed.
- Provide coaching and education concerning medication regime to improve medication adherence, navigating the healthcare system, medical conditions and self-management techniques.
- Promotes clear communication among care team and treating clinicians by ensuring awareness regarding patient care plans.
- Ensure adherence to clinic and departmental policies and procedures. Patient care assignment may include adult and geriatric age groups.
- Evaluates clinical care, utilization of resources, and development of new clinical tools, forms and procedures.
- Initiate patient care conferences as needed.
- Directs the work of LPN Care Coordinators, including supervising patient screening, education and following the care coordination care plan.
Minimum Education/Certification Licenses:
- Current RN Licensure in New York
- Associates Degree in Nursing
- Bachelor’s Degree in Nursing (BSN)
- Certificate in Case Management (CCM, ACM)
- Excellent communication and teaching skills
- Self-disciplined, energetic, passionate and innovative
- Demonstrated commitment to collaboration with providers and their clinical teams to enhance patient self-management
- Diligent attention to accurate recording of patient information
Crouse Medical Practice, PLLC is an Equal Employment Opportunity Employer-M/F/D/V. To apply, please, complete our Online Application or email your resume to Human Resources at firstname.lastname@example.org.