bout the Job: Check all associated application documentation thoroughly before clicking on the apply button at the bottom of this description. The Nurse Care Coordinator organizes team-based care planning to provide support and comprehensive health services to individuals, mainly focusing on individuals with higher risk and complex needs, through effective partnerships with patients, their caregivers/families, community resources, and their healthcare providers. Performs short term transitional care activities and longer-term care planning for complex patients through facilitation of a shared care plan across the continuum of care to achieve well-coordinated, timely, cost effective, high-quality care that is patient and family centered. What Youll Do: Manages a panel of active patients requiring complex care management and care coordination support Collaborates with the multidisciplinary team, including the patient and their family, to design and implement holistic individualized plans of care for patients enrolled in care coordination programs Communicates necessary and important information to physicians, supervisors, patients, and staff Assess patient and familys unmet health and social needs as well as health literacy and identifies strategies to resolve needs Provides care coordination support across settings and transitions of care including discharges from acute and post-acute settings, specialty settings and provider transitions Who You Are: Graduate of an accredited school of nursing. Bachelor of Science in Nursing, Preferred Current New Hampshire, compact, or multistate licensure as Registered Nurse, Required Specialty Certification i.e. ambulatory nursing, CCM, CCTM, Guided care, CHCQM, Preferred 5 years nursing experience in acute, skilled nursing, community health and/or ambulatory setting, Required Why Youll Love Us: Health, dental, prescription, and vision coverage for full-time & part-time employees Short term, long term disability, Accident insurance, & life insurance Tuition Reimbursement Referral bonuses Accrued earned time for full-time & part-time employees 403b Retirement plans, with generous employer contributions And more!