- Conduct timely outreach and follow-up with patients who have experienced a transition of care, ensuring comprehensive assessments are completed and necessary follow-up appointments are scheduled.
- Collaborate with the healthcare team to identify and manage high-risk patients, develop individualized care plans, and document care activities in the Electronic Health Record (EHR).
- Utilize data from various technology platforms, including EHR systems and web applications, to optimize workflow efficiency and patient management.
- Coordinate medication management, including reconciliation after care transitions, and ensure adherence to treatment plans.
- Monitor and coordinate home care, hospice services, and ancillary services to support patient needs as directed by the primary care team.
- Implement population health management strategies, leveraging technology-based tools and evidence-based guidelines for preventive care and disease screening.
- Facilitate patient engagement activities through education, goal-setting, and collaboration with providers to achieve optimal health outcomes.
- Provide mentorship, coaching, and education to medical assistants (MAs) to enhance their skills in patient engagement, chronic disease management, and technology utilization.
- Maintain professional competencies through ongoing education and training, ensuring compliance with licensure and certification requirements.
- Current and active New Jersey Registered Nurse (RN) license; Bachelor's degree in nursing preferred.
- Certification in Case Management (CCM) or relevant certification is preferred.
- Minimum of 3 years of experience in case management, direct patient care, or healthcare coordination roles.
- Proficiency in electronic health records (EHR) systems and other healthcare technology platforms.
- Strong analytical skills with the ability to make sound clinical judgments.
- Effective communication and interpersonal skills, with the ability to collaborate with diverse healthcare team members.
- Excellent organizational skills and the ability to prioritize tasks in a fast-paced environment.
- Proactive problem-solving skills and the ability to navigate complex patient care scenarios.
- Commitment to continuous learning and professional development.
- Valid New Jersey driver's license and willingness to travel to various Vanguard Medical Group locations for meetings and training sessions.
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Nurse Care Coordinator - Verona, United States - Vanguard Medical Group
Description
Job Description
Job DescriptionSalary:Nurse Care Coordinator - Join Our Verona, NJ Team
About Us: Vanguard Medical Group is an independent primary care group practice with 11 offices throughout New Jersey. We are committed to providing evidence-based healthcare that achieves quality outcomes that improve the health and safety of our patients and the populations we manage. We also strive to take care of our people, and that's not just patients. We want to ensure that our clinical and administrative staff have a good work-life balance, are engaged at VMG, and experience joy at work.
Position Type: Full-Time
Location: Verona, NJ
About the role: The Nurse Care Coordinator plays a pivotal role in facilitating patient care coordination, managing outcomes, and supporting quality initiatives within the primary care setting. Working closely with a multidisciplinary healthcare team, the Nurse Care Coordinator focuses on patient-centered care, health coaching, and the management of complex patient needs. This position is based in our Verona, NJ office.
Job Responsibilities:
Requirements:
Life at Vanguard:
We are the innovators and visionaries in medical science, with the health of our patients as the ultimate goal. To take care of our patients, we hire warm and caring professionals who value and respect others, and who seek to achieve excellence in all they do. We take care of our team too We offer a unique work environment where you can maximize your capabilities and contributions and we value everyone's input. Some of our benefits include medical, dental and vision insurance, generous paid time off, 401(k) plans with employer match, and leadership opportunities.
