Serves in an expanded nursing role as part of an interdisciplinary team to promote preventative patient care, offer screening services, and coordinate disease management services while also providing primary clinical support to the provider, patient and their family to assist in the diagnosis and treatment of the patient's condition. Functions as both a patient care coordinator and clinic RN. Follows up on diagnostic testing to ensure completion, accuracy, and filing of same in medical record to ensure continuity and quality of care. Assists clinic team with triage of inbasket messaging as needed and management of patient interaction with the clinic. Promotes a clean environment. Meets the qualifications to provide care for patients in specific age range on their assigned clinical area.
The Primary Care Nurse Coordinator assists with integrating identified patient needs, intervention pathways, clinical guidelines and diagnostic tests to develop individualized plans of care. The RN performs duties to provide the highest level of patient care and maximize patient satisfaction.
The Primary Care Nurse Coordinator performs Medicare wellness visits on a pre-identified population within the clinic to support wellness planning and management of chronic disease. Also provides education visits including diabetic education and other chronic disease education for populations identified through wellness visits, patient registries or by the clinic provider.
Enrolls patients in Chronic Care Management program with monthly follow-up outreach to patient to address patient needs and monitor disease course.
Outreaches to clinic patients post-hospital discharge for transitions of care coordination.
Works under the general direction of the Site Lead for daily operational issues.
COMPETENCIES AND SKILLS:
Demonstrates outstanding organizational skills and effective communication skills.
EDUCATION AND/OR EXPERIENCE:
Graduate of accredited nursing program, current PA RN license or eligible for licensure.
Minimum of five years of experience in clinical nursing, case management, or long term care (required).
Must be qualified to pass medications. Must be BLS certified.
Minimum one year ambulatory care experience preferred.
American Academy of Ambulatory Care Nursing certification within two years of hire date
WORKING CONDITIONS/PHYSICAL DEMANDS:
Work is typically performed in a clinical environment.
The specific statements shown in each section of this description are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.
OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation.
ABOUT GEISINGER: Geisinger is a physician-led health system comprised of approximately 30,000 employees, including nearly 1,600 employed physicians, 13 hospital campuses, two research centers, and a 583,000-member health plan Geisinger is nationally recognized for innovative practices and quality care. Geisinger serves more than 3 million people in central, south-central and northeast Pennsylvania and also in southern New Jersey with the addition of National Malcolm Baldridge Award recipient AtlantiCare, A member of Geisinger. In 2017, the Geisinger Commonwealth School of Medicine became the newest member of the Geisinger Family.
We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners.* Perhaps just as important, from senior management on down, we encourage an atmosphere of collaboration, cooperation and collegiality. For more information, visit www.geisinger.org, or connect with us on Facebook, Instagram, LinkedIn and Twitter.
** Does not qualify for J-1 waiver. We are an Affirmative Action, Equal Opportunity Employer Women and Minorities are Encouraged to Apply. All qualified applicants will receive consideration for employment and will not be discriminated against on the basis of disability or their protected veteran status.
*Domestic partner benefits not applicable at Geisinger Holy Spirit.
Geisinger serves more than 3 million people in central, south-central and northeast Pennsylvania and also in southern New Jersey with the addition of National Malcolm Baldridge Award recipient AtlantiCare, A member of Geisinger. In 2017, the Geisinger Commonwealth School of Medicine became the newest member of the Geisinger Family. Geisinger is nationally recognized for innovative practices and quality care. A mature electronic health record connects a comprehensive network of 13 hospital campuses, two research centers and nearly 1,600 Geisinger primary and specialty care physicians.Geisinger is an integrated health services organization widely recognized for its innovative use of the electronic health record and the development of innovative care delivery models such as ProvenHealth Navigator®, ProvenCare® and ProvenExperience®. As one of the nation’s largest health service organizations, Geisinger serves more than 3 million residents throughout 45 counties in central, south-central and northeast Pennsylvania, and also in southern New Jersey at AtlantiCare, a Malcolm Baldrige National Quality Award recipient. In 2017, the Geisinger Commonwealth School of Medicine and Geisinger Je...rsey Shore Hospital became the newest members of the Geisinger Family. The physician-led system is comprised of approximately 30,000 employees, including nearly 1,600 employed physicians, 13 hospital campuses, two research centers, and a 583,000-member health plan, all of which leverage an estimated $12.7 billion positive impact on the Pennsylvania and New Jersey economies. Geisinger has repeatedly garnered national accolades for integration, quality and service. In addition to fulfilling its patient care mission, Geisinger has a long-standing commitment to medical education, research and community service. For more information, visit www.geisinger.org, or connect with us on Facebook, Instagram, LinkedIn and Twitter.