Job Description

: Join a world-class academic healthcare system, UChicago Medicine, as an Ambulatory Care Coordinator.


The Care Coordinator works collaboratively with a multi-disciplinary team to ensure patient needs are met and care delivery is coordinated across the continuum, as well as appropriately reimbursed by payers as contracted. The RN Care Coordinator acts as a patient advocate, responding with empathy and respect to resolve and assist with patient/family concerns. In this role, you will utilize critical thinking skills to perform timely coordination to meet individual\xe2\x80\x99s unique healthcare needs to promote positive outcomes. You will seek the expertise of primary care physicians, medical directors, inpatient case managers, specialists, social workers, and other disciples while working with patients, family members, and Chicagoland community and state agencies to coordinate care for patients with chronic diseases. Positive and professional efforts will be targeted to promote patient/provider satisfaction and to resolve patient care issues with the development of patient-centered care plans. Care plans are developed based on mutual goals for the patient, family, and the provider\xe2\x80\x99s emergency plan, medical summary, and ongoing action plan as appropriate. Close monitoring of patient adherence and goal progress takes place within the plan of care, and changes are facilitated as needed. The Care Coordinator is responsible for maintaining hospital compliance with the Quality Improvement Organization (QIO) series and CMS guidelines. In addition, the Care Coordinator provides and assesses quality, levels of care and identifying and reporting potential risk management issues. The incumbent performs duties and tasks in accordance with performance standards established for the job. They are also responsible for participation in, and completion of, all patient safety initiatives appropriate to the position. The Care Coordinator conducts all job responsibilities in coalescence with the University of Chicago Medicine PRIDE values.
Essential Job Functions:

• Works in conjunction with a developing high-performing team that incorporates leadership principles to assess, plan and initiate patient care.
• Maintains the ability to work in a high volume caseload, based on department expectations, and deal with rapid changing priorities.
• Demonstrates the ability to collaborate with multidisciplinary team for successful preventative care visits to reduce the severity of the chronic disease and avoidable acute illness.
• Creates and manages a patient centered plan of care for acute and chronic conditions to promote health behaviors in all populations and ensure navigation assistance within the healthcare system.
• Identifies, plans, and facilitates strategies to provide appropriate clinical health coaching to support patients with self-management of their chronic disease and lifestyle changes to mitigate health risk.
• Identifies patients who require community support and facilitates a comprehensive approach to the social determinants of health to help patients overcome obstacles that keep them from receiving the care they need.
• Ensures that all critical elements of the care plan and transition of care plan have been communicated to physician, multi-disciplinary team, patient and family including expediting teaching needs.
• Completes tasks related to transition of care documents, quality care gaps, and various other quality and performance measure processes. Ensures adherence to Quality Standards and Participation in Quality Monitoring and Improvement.
• Assumes responsibility for own professional growth and attendance to in-service educational opportunities.
• Performs other duties as assigned and pays close attention to detail and accuracy of documentation of records along with proficient use of multiple databases and IT resources.

• Maintains ongoing member case load for regular outreach and management.

• Must have a Bachelor\xe2\x80\x99s degree in Nursing from an accredited academic body.
• Must be a licensed Registered Nurse with a valid, unrestricted State license.
• Must have a minimum of three years\' experience working in a clinical setting as a Registered Nurse.
• Must have experience working in case management or care coordination.

• Certification in Case Management preferred. (i.e. CCM, CCCTM, etc.).

• Job Type/FTE: Full Time - 1.0 FTE
• Shift: 8-hour shift - 8:00am - 4:30pm
• Unit/Department:Transformative Care
• CBA Code: NNU National Nurses United