Registered Nurse Care Coordinator (RNCC) Case Management

About this role

We are recruiting for a mission-driven Registered Nurse Care Coordinator (RNCC) Case Management to join our team! We're with you for life’s journey. At Denver Health, purpose isn’t just something we believe in—it’s something we live every day, for life’s journey.

Our Values Respect | Belonging | Accountability | Transparency

Department Eastside Pediatric/Teen Clinic

Job Summary

Under general supervision, the RN Care Coordinator (RNCC) is responsible for facilitating and coordinating the care delivered to an assigned group of patients through multidisciplinary and patient/family collaboration to ensure quality and cost-effective outcomes are delivered within appropriate care coordination parameters. Coordination involves assessment, planning, support, and evaluation of patient care and related outcomes. Activities to be performed are facilitation of appropriate status and level of care, screening for high risk and transition of care needs, interviews with patient/family, and progression of care facilitation with the healthcare team. Encounters occur face to face, telephonically, and electronically with patients in clinic, at home, at school, and at work. Is an active contributor in the development of systems (e.g. care maps, clinical paths) to improve the care of assigned patient populations. Helps ensure compliance with state, federal and third-party payor requirements.

T he Connections for Kids Clinic (CFKC) is a medical home for children (0-18 years) in the custody of child welfare. CFKC offers trauma-informed, multidisciplinary care with continuity across placement types (foster, kinship, congregate) and changes including reunification and adoption.  CFKC integrates medical care, behavioral health, dental health, social work and other expertise to provide comprehensive care in a coordinated visit.  The ideal candidate for this position will be comfortable communicating with the medical team, caregivers (foster, kin, family of origin), and community professionals (child welfare case workers, home health agencies). CFK will operate four half-day sessions per week at various Denver Health clinic sites.

Essential Functions :

• Uses Nursing Process to Create patient and family centered goals and plans Establish and maintain patient and family centered relationships Collect assessment data relating to patient health needs and concerns. Analyze assessment data to determine patient and family needs. Work with patient and family to identify goals and outcomes. Develop evidence-based interventions and care plans to support goals and outcomes. Implement plan with patient, family, care team. Conduct systematic and timely evaluation of outcomes of nursing care and care plan. Document care according to organizational standards, contractual and regulatory requirements, state and federal laws. Encourage preventative care. Assist and educate patient and caregivers. Support patients and caregivers in developing skills to promote, maintain and restore health. Review and educate patient and caregivers on medications and treatments. Incorporate cultural humility, language appropriateness, health literacy, and preference into patient care, care plans and communication. (40%) • Care Management Work within and in support of the health care team to coordinate the delivery of care within the clinic setting, throughout the organization, and across healthcare settings. Delegate appropriate intervention to care team members based on scope, competency, state practice act, standard work and organizational policies. Provide information to the healthcare team, including patient and family regarding resources and benefits to support safe transitions and timely provision of healthcare services. Advocate to secure benefits for patient and identify potential barriers to payer coverage. Serve as point of contact with the patient and among healthcare services and organizations. Coordinate community resources. Provide care management to appropriate patients and according to organizational policies and payer guidelines. (40%) • Professional Practice and Collegiality Flexible and accommodating to patient, clinic setting, community, payer, and organizational needs. Attain and maintain knowledge and competency to reflect current evidence-based nursing practice. Proactively assess needs of others: care team members, patients, and families. Contribute to positive, supportive, healthy and inclusive work environment through positive interactions, respectful communication and creative solutions. (20%)

Education : • Associate's Degree Completion of a nursing education program that satisfied the licensing requirements of the Colorado State Board of Nursing for Registered Nurses. Required

Work Experience : • 1-3 years clinical experience in a hospital, acute care, home health/hospice, direct care or case management required. Required • Bilingual in English/Spanish Preferred.

Licenses : • RN-Registered Nurse - DORA - Department of Regulatory Agencies Required and • BLS-Basic Life Support (BLS/CPR) - AHA - American Heart Association Required

Knowledge, Skills and Abilities : • Knowledge and understanding of case management/coordination of care principles, programs, and processes in either a hospital or outpatient healthcare environment. • Effectively collaborate with and respond to varied personalities in differing emotional conditions, and maintain professional composure at all times. Strong customer service orientation and aptitude. • Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action. • Ability to communicate verbally and in writing complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others. • Proficient in Microsoft outlook, Word, and Excel • Experience with electronic health records and documentation of care coordination services preferred.

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