Job Description - RN Care Coordinator-FT-Days-CPC+ Program-Clinical Quality-INTEGRIS Medical Group( - Job Number: 710598) - Description Care Coordinator Job Code: 1335 Position Summary: The Care Coordinator is responsible for providing outreach, disease management/case management, education/training and motivational support to INTEGRIS Health Partners covered lives to encourage healthy lifestyle choices and reduce long term effects of chronic illness. INTEGRIS Health is an Equal Opportunity/Affirmative Action Employer. Essential Functions: The Care Coordinator responsibilities include, but are not limited to, the following: * Provide outreach, disease management, education and other clinically based activities to patients managing various chronic health conditions. * Assess and identify participant's readiness, willingness and ability to change; identify their coaching, support and educational needs; determine and provide relevant community and/or health care resources to support solutions; provide educational tools to promote self-management. * Develops interventions and sets goals for behavioral modification within the scope of nursing practice. * Conducts health and wellness coaching sessions to assist participants in making lasting changes to their health and wellness. * Monitor and document the patient's progress toward his or her optimal level of wellness. * Communicates, as needed, with service delivery partners, physicians and other health professionals to provide case coordination and develop a plan of care that facilitates the efficient use of health care resources. * Demonstrates skills in effectively coordinating and monitoring care to promote quality and cost effective outcomes. * Promote wellness and provide education regarding preventative care measures. * Acts as a liaison between physician practices, facilities and outside entities to resolve continuum of care issues related to patient care. * Proactively follows up with patients discharged from all hospitals, rehab facilities and emergency rooms to ensure patient has an appointment with their provider and reviews any unmet needs prior to the upcoming appointment. * Analyzes clinical data generated from MedVentive clinical performance reporting system and utilizes said data for tracking and care coordination purposes. Accountability: Reports to Manager or Director. Required Physical Demands (Subject to Reasonable Accommodation): Keyboarding/Dexterity: Frequently; activity exists from 1/3 to 2/3 of the time Standing/Walking: Occasionally; activity exists up to 1/3 of the time Strength (Lift/Carry/Push/Pull): Sedentary (exerting up to 10 pounds of force occasionally) Talking (Must be able to effectively communicate verbally): Yes Seeing: Yes Hearing: Yes Color Acuity (Must be able to distinguish and identify colors): No This position may have additional or varied physical demand and/or respiratory fit test requirements. Please consult the Physical Demands Project SharePoint site or contact Risk Management/Employee Health for additional information. Environmental Conditions: Normal office environment. When working in clinical areas, potential for exposure to infections and communicable diseases, blood and body fluids, electrical equipment, chemicals. Must follow standard precautions. All applicants will receive consideration regardless of membership in any protected status as defined by applicable state or federal law, including protected veteran or disability status. - Qualifications Qualifications:

• RN, BSN Preferred * 3 years clinical experience * Current Oklahoma RN license * Previous work experience with educating patients and patient goal setting preferred - If you are a person with a disability and need assistance in the employment process, contact INTEGRIS Health Human Resources about a reasonable accommodation at 888-951-2558 TTY/Phone or via email at INTEGRISApplicantAccommodation@integrisok.com.