Overview Catholic Health is one of Long Island’s finest health and human services agencies. Our health system has over 16,000 employees, six acute care hospitals, three nursing homes, a home health service, hospice and a network of physician practices across the island. At Catholic Health, our primary focus is the way we treat and serve our communities. We work collaboratively to provide compassionate care and utilize evidence based practice to improve outcomes – to every patient, every time. We are committed to caring for Long Island. Be a part of our team of healthcare heroes and discover why Catholic Health was named Long Island's Top Workplace! Job Details The High-Risk RN Care Coordinator is responsible for oversight and care coordination services for the departments high-risk, high-cost patients. The High-risk RN Care Coordinator ensures a patient-centric care approach, and provides a model of care that ensures the delivery of quality, efficient, and cost-effective outpatient healthcare services to reduce unnecessary emergency room visits and inpatient readmissions. The High-Risk RN Care Coordinator will work collaboratively with the patients’ health care team to foster optimal outcomes. Duties and Responsibilities: Oversees the identification and management of high-risk/high-cost assigned patients Ongoing communication and collaboration with inpatient, homecare, providers, and community-based organizations to ensure a patient centered care approach and optimal health. Establishes relationship with patient, identifying and documents goals of care and advanced directives. Refers to palliative care and hospice when appropriate Assesses patient’s readiness to change Works with Care Manager Coordinator to ensure SDOH’s are addressed Establishes solid working relationship with ED and Care Management teams in all CH Hospitals Attends hospital Readmission meetings Attends VBC payer clinical meetings as necessary Assists when needed with the coordination of care during all transitions within the healthcare continuum. Reveals ability to work autonomously and be directly accountable for results. Incorporates excellent written, verbal, and listening communication skills, positive relationship building skills, and critical analysis skills Possess the skill to function effectively in a fluid, dynamic, and rapidly changing environment Displays the proven ability to positively influence behavior and outcomes. Protects confidentiality of data and intellectual property; ensures compliance with national health information projection guidelines. Performs duties that may be in an embedded or remote environment. Serves as a role model for education and professional nursing practice CH Hospital onsite rounds as needed Other tasks and duties as required Position Requirements/Qualifications: Requires Registered Nurse with current license. CCM or CCTM a plus but not required. BSN preferred Bi-lingual Spanish preferred Minimum of three years recent experience to match responsibilities above such as acute care, home health or skilled nursing facility with a demonstrated working knowledge of VBC. Experience as a Care Manager required. Experience with IT solutions such as electronic health record, learning management or disease/care management systems a plus. Critical thinking skills and ability to analyze complex data sets required. General computer knowledge and capability to use computers required. Must meet all productivity standards Must attend all required meetings remotely and in person as required Must have private, secured workplace Salary Range USD $110,000.00 - USD $120,000.00 /Yr. This range serves as a good faith estimate and actual pay will encompass a number of factors, including a candidate’s qualifications, skills, competencies and experience. The salary range or rate listed does not include any bonuses/incentive, or other forms of compensation that may be applicable to this job and it does not include the value of benefits. At Catholic Health, we believe in a people-first approach. In addition to the estimated base pay provided, Catholic Health offers generous benefits packages, generous tuition assistance, a defined benefit pension plan, and a culture that supports professional and educational growth.