RN Care Coordinator – Ambulatory Virtual Nursing
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Job Description
Emory Healthcare RN coordinating virtual care, patient outreach, and complex disease management. Improving outcomes through telehealth, care plans, referrals, and multidisciplinary collaboration.
Responsibilities:
- Conduct proactive patient outreach and care coordination for assigned patient panels
- Assess patient health status, risks, barriers, goals, and progress toward care-plan completion
- Develop patient-centered outcomes and care plans using a holistic, evidence-based, team-based approach
- Conduct targeted outreach to high-risk and post-discharged patients
- Serve as a primary contact and facilitate access to services
- Collaborate with patients, families, healthcare teams, community organizations, and Emory care coordination teams
- Enhance health literacy using teach-back and other learning-validation methods
- Provide self-management, health-promotion, and disease-prevention support using information technologies
- Evaluate care-coordination outcomes and update patient care plans
- Close specialty and chronic-disease care gaps
- Document evaluative results and monitor performance and quality-improvement measures
- Integrate data analysis and performance-improvement initiatives into practice
- Apply critical thinking and clinical judgment to population-health interventions and individual patient care
- Participate in professional organizations and continuing-education activities
- Ensure completeness of records and orders from discharging acute facilities in post-acute areas
- Facilitate transitions across inpatient, SNF, IRF, HHA, and home settings
- Monitor therapy progress and discharge readiness
- Maintain relationships with Medicare nurses/teams and network leaders to escalate post-care outcomes
Requirements:
- Graduate of an accredited nursing school
- Bachelors degree in Nursing (BSN) required
- Three (3) years of healthcare experience required
- Must have a valid, active unencumbered Nursing license or temporary permit approved by the Georgia Licensing Board
- BLS Healthcare Provider certification
- An active compact/multistate license (eNLC) is required within 60 days of hire for virtual care activities that may include multi-state practice
- Care Management experience preferred
- Ability to work the 8:30am-5pm shift
- Ability to complete 6-8 weeks of onsite training
- Ability to work in environments with potential exposure to blood-borne pathogens, bio-hazardous waste, chemicals/gases/fumes/vapors, communicable diseases, electrical shock, radiation, and other listed environmental factors
- Travel may be required
- Use of personal protective equipment, including respirators, may be required
Benefits:
- Comprehensive health benefits that start day 1
- Student Loan Repayment Assistance & Reimbursement Programs
- Family-focused benefits
- Wellness incentives
- Ongoing mentorship, development, and leadership programs
- Reasonable accommodations for qualified individuals with disabilities upon request
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