Community Health Systems Continuum of Care Coordinator (RN)-1.0 FT Days in Scranton, Pennsylvania


The Continuum of Care Coordinator RN (CCC-RN) is responsible for improving patient's level of wellness, reducing unnecessary readmissions and ensuring appropriate utilization of in-network healthcare resources. This is achieved by monitoring the ACO Care Continuum for patients discharged from CHS Hospitals; which includes discussing utilization patterns of Participating and Non-participating resources, including physicians, hospitals and post-acute care providers. The CCC will collaborate with the Hospital Leadership and Case Managers to review trends in resource utilization. The CCC will seek to provide assistance to patients who express concerns or additional care needs. The CCC will also seek to understand readmission drivers and opportunities to reduce 30-day readmission penalties. Will require traveling the local market and within the ACO.


Graduate of an accredited school of professional nursing. A minimum of five years of strong clinical/healthcare experience required. Current working knowledge of discharge planning, utilization management, case management and disease management. Understanding of pre-acute and post-acute venues of care and post-acute community resources, physician office routines, and transitional procedures for pre- and post-acute care. 1-3 years Supervisory and project leadership experience. Knowledge of Medicare and ACO practice management a plus. Prior experience as a Care Navigator for high-risk patient populations a plus. Demonstrated ability to communicate effectively in person and via telephone with patients, families/caregivers, physicians, physician office staff, and Post-Acute providers using appropriate dialogue and customer service competencies. Can aggregate and evaluate patient level data focusing on medical, psychosocial, and the education needs utilizing established post-acute criteria. Ability to perform multiple activities, meet deadlines, solve problems, utilize resources, make independent decisions, and work well in a team-based environment. Hands-on individual with great attention to detail, high personal accountability, and strong drive to develop him/herself while learning business model. Strong organizational skills. Excellent written and verbal communication skills. Proficient in Microsoft Office products such as Word, Excel, PowerPoint, Outlook.

Current Pa Registered Nurse license

Job: Case Management / Utilization Review

Organization: Moses Taylor Hospital

Location: PA-Scranton

Requisition ID: 1838767