Job Description

Job Description: As an advocate for the patient, the RN Coordinator for Care Coordination and Resource Services assists patients to reach optimal function and health in an appropriate environment that would support their needs. The RN functions within the full scope of the nursing practice to include the essential job functions that extend beyond the episodes of care; and furthermore, to encompass the coordination of care across the continuum. The continuum of care includes inpatient-to-outpatient, and to the community. The length of time a RN would follow a patient is determined by the patient’s needs and attainment of goals prescribed in a care plan. This position performs cost benefit analyses of care options, balancing the needs and available resources. The RN utilizes independent judgment and decision making to ensure provision of the most appropriate use of resources and to achieve reduction in unnecessary hospital utilization. The RN monitors patients throughout transitions of care to reduce potential for readmission. This position makes autonomous decisions regarding risk and needs assessment, care planning and utilization of resources, based on established policies and procedures, and the community standards of practice.Education/Experience/Skills Requirements: Education Graduate of Accredited School of Nursing- Required Master's Degree in Case Management- Preferred Experience 1 year Care Coordination or Care Management - Required Two (2) years Nursing - Ambulatory Services - Required Two (2) years Nursing – Acute Care - Preferred Ambulatory - Independent Physician Practice (IPA) or Medical Group - Preferred Health Plan - Preferred Care Management Company- Preferred Certifications/Licensures RN Registered Nursing - California Board of Nursing- Required BLS Basic Life Support - American Heart Association- Required CCM Certified Case Manager- CCMC Commission for Case Management - Preferred Knowledge, Skills, and Abilities Knowledge and skills with EPIC (EMR), PC, word processing, Excel, and database programs. Demonstrates organizational skills, ability to set priorities, manage multiple demands, and complete tasks under strict timelines. Leadership skills to delegate and provide guidance to staff and hold othersaccountable. Ability to communicate and interact respectfully with patients and families of diverse functional abilities, social, economic, and culturalbackgrounds to support patient autonomy and safety. Ability to work independently with minimal direction and exercise discretion to make independent judgments, seeking review when decisions represent significant departure from established guidelines. Monitors and assesses the flow of information/communication to keep management and other staff appraised of critical information or potential problems. Demonstrates effective oral and written communication, interpersonal, problem-solving, conflict resolution, presentation, timemanagement, and positive communicationskills. Communicates effectively with community leaders, staff, and management both verbally and in writing; uses proper grammar, punctuation, and business formats as appropriate. Utilizes effective organizational tools to ensure activities are well planned, communicated, and tracked until completion and due dates are met. Demonstrates financial awareness by responsible use of equipment and supplies to control costs. Effectively participates as a member of internal and external teams and work groups as needed. Knowledge, Skills, and Abilities Clinical Care Coordination In-depth knowledge of Geriatrics including common health and functional changes in the aged, and various chronic disease processes. In-depth knowledge of current treatments and physical and psychosocialeffects. Strong clinical assessment and critical thinking skills to develop a comprehensive plan of care that is appropriateto patients with complex medical, emotional, and socialneeds. General knowledge of common diagnoses andprocedures. General knowledge of individual and family development over the life span, and the influences of cultural and spiritual values in healthcare. General knowledge of government and private insurance benefits, e.g.,Medi-cal, Medicare, DRGs, and managedcare. General knowledge of available health care and community resources appropriate forpopulations served. Demonstrated skills in motivating, mentoring, coaching and redirecting clients in order to achieve compliance withvarious necessary medical, social, and functionalinterventions. Ability to serve as a health coach to patients in all categories - from wellness, to at-risk due to lifestyle habits, newlydiagnosed conditions, chronic disease and to end-of-life. Work Rules and Practices Patient Safety - Competency Maintains strict confidentiality and demonstrates a clear understanding of HIPAA Privacy and California Confidentiality of Medical Information Act provisions surrounding patient specific processes; maintains compliance with John Muir Health policies. Provides a safe working environment for the department by having knowledge of relevant policies and procedures. Reports and corrects unsafe conditions. Follows ergonomic policies, procedures and recommendations from the Employee Health Department. Adheres to Health System and department policies and procedures regarding sick time, attendance, rest and meal breaks, dress code, safety, etc. Communication – Competency Develops and maintains professional working relationships among department colleagues, providers, collaborating partners, and the JMH system employees. Follows appropriate communication channels and is open to provide/receive constructive feedback in a professional manner. Supports the mission, philosophy, and goals of John Muir Health. Work Shift: 08.0 - 08:00 - 16:30 No Waive (United States of America)Pay Range: $83.82 - $113.15HourlyOffer amounts are based on demonstrated/relevant experience and/or licensure. Pay will be adjusted to the local market if hired outside of the Bay Area. Note: Positions at JMH which are exempt (not eligible for overtime) under the level of Manager are listed as hourly for compensation purposes on this posting. The work shift will contain the word ‘exempt’ on it. Scheduled Weekly Hours: 40--s-p-m1-- By applying, you consent to your information being transmitted by Monster to the Employer, as data controller, through the Employer’s data processor SonicJobs. See John Muir Health Terms & Conditions at and Privacy Policy at and SonicJobs Privacy Policy at and Terms of Use at

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