RN Care Coord - PCCN
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Position Summary
Posting Note: The PPCN Nurse Coordinator is a highly specialized and independent role within Phoenix Children’s. In this position, you will serve as a key liaison between patients, families, providers, and community partners, conducting outreach to educate and connect them with the services available to support their care journey.
This is a fully remote position, however the incumbent must reside in Arizona and be available to be onsite several times per month for meetings, training, and related activities (no exceptions). Experience working in a remote position is preferred.
Key Responsibilities
• Independently manage outreach to patients, families, and providers regarding PPCN services
• Coordinate care across a wide spectrum of cases, from routine to highly complex
• Collaborate closely with community agencies, social workers, hospital staff, and medical providers
• Identify and dismantle barriers to care through strong problem-solving and advocacy
• Influence and align cross-organizational partners to ensure optimal patient outcomes and satisfaction
Qualifications
• Active RN license
• Minimum 3+ years of experience in a case management role
• Demonstrated success working with complex patient populations
• Proven ability to collaborate across organizations and disciplines
• Strong critical thinking, communication, and problem-solving skills
• Experience managing a large and diverse patient population (approximately 170,000 lives)
Additional Information
• Phoenix Children’s will provide all necessary technology to support success in this role
• No new graduates will be considered
Care coordination is the deliberate organization of patient care activities and sharing information among all the participants concerned with a patient`s care to achieve safer and more effective care. The goal of care coordination is to facilitate the appropriate and efficient delivery of health care services both within and across systems. Care Coordination is a truly collaborative approach. RN Care Coordinators are excellent problem-solvers who are dedicated for finding the best solution to their patients’ needs. They have strong research abilities that enable them to seek out resources related to each client’s specific life situation. RN Care Coordinators are highly organized and efficient, allowing them to serve as many clients as possible without sacrificing personalized attention and enjoy taking initiative to improve their patients’ quality of life. This position advocates, guides, and intervenes on behalf of the patient population PCCN serves in coordination with the PCP to support patients/families in understanding and navigating various health care systems. Patient/family needs are identified through needs assessments and needs are met through completing tasks in the Pediatric Care Constellation (PCC) system. This position works closely with the rest of the Integrated Care Coordination team to coordinate, problem solve, troubleshoot barriers to care and meet the needs of patients and families. This position works independently, receiving supervision of work activities from the Manager of Integrated Care Coordination.
Position Duties
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Care Management Activities
a) Completed needs assessments with patient/families to identify assistance needed
b) Identifies and coordinates referrals/prior authorizations for specialty medications, DME, home health, etc.
c) Assists with the facilitation and positive outcome of prior authorizations. Support families understanding of denials, including next steps.
d) Works closely with Care Navigators and Social Service staff to ensure all patient/family needs are addressed; mental health, community resources, appointments, etc.
e) Escalates unresolved barriers to the Manager of Integrated Care Coordination and Chief Medical Officer
f) Maintains timely, complete, and accurate documentation in compliance with PCCN policies and procedures.
g) Supports initiatives to improve quality performance against pre-defined gap in care, cost of
h) Work closely with provider offices and support staff, in a professional manner, to facilitate patient/family needs being met
i) Multi-tasks communications through email, telephone, IM, text, and Vocera
j) Ability to utilize multiple computer monitors with various applications open simultaneously to ensure the highest levels of efficiency
k) May facilitate set up of multi-provider Care Conference on behalf of patient/families -
Collaboration
a) Cultivates and maintains effective interaction/communication with all stakeholders.
b) Utilizes all available tools to ensure timely, effective, and appropriate communications
c) Serves as a clinical resource and subject matter expert for the team
d) Complete Nurse Consults timely, as requested by teammates; outreach to families to determine the type of assistance they are requesting.
e) Escalate issues and required support to Manager, Integrated Care Coordination and Chief Medical Officer (when appropriate) -
Transitions in Care
a) Calls patients/families transitioning home from a hospital or ED stay within specified time frame to monitor and support execution of the discharge summary. Identify and assess additional needs that support the goal of reducing the likelihood of re-admission or future avoidable admissions.
b) Identifies additional needs patients/families may have that may not be documented within the discharge summary
c) Supports medication compliance, prior authorization, and treatment adherence. Assist patient/family to work through medication barriers, such as issues with the orders, pharmacy, or insurance.
d) Provide approved education about new conditions, new medications, disease process, etc. Refers patients/families back to their provider for patient specific treatment plan guidance.
e) Facilitate successful return to school and work notes after hospitalization
f) Work with school nurses, as needed, to ensure medication or treatment is successful if ordered during the school day. -
Education
a) Maintains professional competency by regularly participating in a variety of educational programs and in-services, reviewing relevant professional publications, participating in community based committees related to service line responsibilities, and/or participating in professional societies to ensure ongoing awareness of current methodologies, practices and philosophies as applied to the patient care population. -
Customer Service
a) Communicates clearly in both written and verbal communications with all internal and external customers.
b) Provides excellent service routinely in interactions with all internal and external customers.
c) Responds to email within 24 hours or one business day. -
Performs miscellaneous job related duties as requested.
Phoenix Children's Mission, Vision, & Values
To advance hope, healing and the best healthcare for children and their families
VisionPhoenix Children's will be the leading pediatric health system in the Southwest, nationally recognized for exceptional care, innovative research and advanced medical education.
We realize this vision by:
- Offering the most comprehensive care across ages, communities and specialties
- Investing in innovative research, including emerging treatments, tools and technologies
- Advancing education and training to shape the next generation of clinical leaders
- Advocating for the health and well-being of children and families
- We place children and families at the center of all we do
- We deliver exceptional care, every day and in every way
- We collaborate with colleagues, partners and communities to amplify our impact
- We set the standards of pediatric healthcare today, and innovate for the future
- We are accountable for making the highest quality care accessible and affordable