Huggins Hospital

  • Nurse Care Coordinator

    Posted Date 2 weeks ago(4/9/2018 10:04 AM)
    Job ID
    # Positions
    Location: State/Province Full Name
    New Hampshire
  • Overview

    Under the general supervision of the Manager of Population Health & Care Coordination, is responsible for coordinating clinical care; educating; advocating; and assisting as the health navigator for patients in the Huggins Hospital Medical Practices.  In addition, this position is responsible for assistance with data collection, analysis and reporting.  


    Education: Graduation from an accredited school of Nursing

    Experience: 2 years of experience in a clinical setting preferred, and 1 year in a Patient-Centered environment setting preferred. Experience in chronic disease management, utilization management, and adult acute care preferred.

    Licensure: RN/LPN State of NH


    Patient Centered Care

    • Participates in Patient-Centered team meetings
    • Participates in data collections, health outcomes reporting, clinical audits, and programmatic evaluation related to Patient-Centered Care Coordination initiatives

    Population Health & Quality Improvement

    • Works with the Population Health Manager and IT on care opportunity reports to identify and address preventative care
    • Works to maximize opportunities for quality incentive payments from governmental and private payers related to population health and chronic care management
    • Provides data analytics and reporting for population health and disease management.
    • Participates in quality review, performance improvement, and medical practice patient satisfaction improvement initiatives

    Care Coordination

    • Coordinates continuity of patient care with patients and families following hospital admission, discharge, and ER visits
    • In collaboration with PCP, manages high risk patient care, including management of patients with multiple co-morbidities or those at high risk for readmission to a hospital setting
    • Promotes clear communication amongst a care team and with treating clinicians by ensuring awareness regarding patient care plans

    Direct Patient Care

    • Facilitates health and disease management education
    • Supports patient self-management of disease and behavior modification interventions.
    • Provides comprehensive preventative wellness exams


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