Care Coordination RN (Path to Supervisor)
Reports To: Nursing Manager
Department: Nursing & Clinical Operations
FLSA Status: Non-Exempt / Exempt (RN)
Target Hire Timeline: Urgent (Within 60 Days)
Career Progression Track: Care Coordination Supervisor (Evaluated at 6–12 months)
Job Summary
The Care Coordination RN is a high-impact clinical role designed to provide immediate operational support for Kidney Specialists of Minnesota’s (KSM) expanding Value-Based Care (VBC) initiatives. Reporting directly to the Nursing Manager, this role serves as the primary clinical engine for the newly launched CKD Stage 2–5 Chronic Care Management (CCM) program while providing hands-on support for Renal Care Coordination (RCC) clinical tasks (e.g., CMS Form 2728 validation and chart reviews, dialysis access and dialysis initiation referrals, TCM visits in ESRD).
This position offers a clear career progression pathway into a formal Care Coordination Lead/ Supervisor role as program enrollment scales and restructured RCC workflows stabilize.
Key Responsibilities & Operational Scope
1. Immediate Primary Focus: CCM Program Support & Execution
- Clinical Care Delivery: Partner closely with the Care Manager(s) to drive day-to-day clinical engagement, comprehensive care plan creation, and monthly touchpoints for CKD Stage 2–5 CCM patients.
- Clinical Workflow Delegation: Take direct ownership of clinical CCM workflows, offloading day-to-day program execution from the Nursing Manager.
- Care Team Collaboration: Work in tandem with non-RN Care Managers, serving as a clinical escalation point for complex patient needs, medication reconciliation, and symptom management.
2. Evolving Scope: RCC & Clinical Chart Auditing
- CMS Form 2728 Verification: Apply nephrology and dialysis expertise to review, audit, and track completion of CMS 2728 forms for optimal dialysis starts and regulatory compliance.
- Clinical Chart Reviews: Perform targeted Acumen/Epic chart reviews to audit modality transitions, hospital discharge follow-ups, and specialty referral completions.
- Workflow Refinement: Partner with the Nursing Manager and Systems Operations to provide front-line feedback, helping refine and standardize RCC workflows as they evolve.
3. Clinic Support Duties
- Nursing Capacity Relief: Support day-to-day coverage of RN tasks including referral management, lab review and follow up, prescription enrollments and refills, prior authorizations.
- Clinical Triage & Overflow: Assist with telephone triage when the primary triage nurse team is overwhelmed or understaffed.
4. Leadership Development & Team Mentorship (Path to Supervisor)
- Mentorship & Guidance: Support the onboarding, clinical growth, and daily guidance of Care Managers and clinical support staff.
- Program Leadership Building: Help monitor program metrics and patient enrollment targets, building the operational framework to step into a formal supervisory role within 6 to 12 months.
Qualifications & Requirements
- Education & Licensure: Active Registered Nurse (RN) license with the Board of Nursing in both Minnesota and Wisconsin; BSN preferred.
- Experience: Minimum 2–3 years of clinical nursing experience in nephrology, outpatient dialysis, or clinical care management.
- Knowledge: Familiarity with ESRD documentation (specifically CMS Form 2728), CKD staging, and care plan development.
- Technical Proficiency: Proficient with EMR systems (Acumen / Epic preferred) for chart reviewing and workqueue tracking.