Registered Nurse Care Coordinator - El Pueblo - Care Management

El Pueblo Health Center, 101 West Irvington Road, Building #10, Tucson, Arizona, United States of America

Posted Thursday, December 11, 2025 at 9:00 AM

Salary: $30.50 - $44.17 Depending on experience

Schedule:

Mon-Fri

The Registered Nurse Care Coordinator promotes the mission and vision of El Rio Health through collaborative interdisciplinary teamwork to provide high quality nursing care, patient safety and care coordination to optimize health and minimize the use of tertiary care services. The Coordinator leads disease management and disease prevention activities, developing strategies to assess social determinants of health and measure patient experiences.

The position contributes to the integrated care team’s activities around process improvement, workflow design, and training, allowing staff to work at the top of their licensure and skill set.

• Identifies patients meeting criteria for care coordination through risk stratification and provider referral.
• Engages patients in care coordination.
• Implements clinical interventions and protocols based on risk stratification and evidence‑based guidelines.
• Develops a comprehensive individualized plan of care and targeted interventions that involve patient/family in decision‑making.
• Continuously monitors patient/family response to the plan of care and revises as needed.
• Provides self‑management support, empowering patients/families to build capacity for self‑care with resources and education.
• Coordinates care through collaboration with providers, patients/families, community, and other health‑team members, fostering a team approach.
• Provides follow‑up when patients transition between settings, completing medication reconciliation, specialist follow‑up, and problem‑solving barriers.
• Performs medication management with ongoing regimens and develops patient‑directed self‑management strategies for compliance.
• Maintains an updated list of community resources.
• Maintains required documentation, including preventive care and services performed elsewhere.
• Conducts follow‑up phone calls to ensure goals are met and oversees staff responsible for coordination of prevention activities.
• Uses data systems to monitor gaps in care.
• Monitors EMR tasks and messages to assure timely management of patient/family and provider concerns.
• Ensures a safe work environment, addressing hazards immediately and adhering to health and safety policies and procedures.
• Maintains patient confidentiality in compliance with HIPAA and corporate requirements.
• Demonstrates understanding of and proficiency with Joint Commission Certification (JCC) compliance and reporting requirements.
• Consistently demonstrates AIDET principles and serves as a role model for service excellence with patients, visitors, colleagues, and the community.
• May make home visits as needed and approved by supervisor.
• Promotes a professional environment that respects diversity and multiculturalism, encouraging communication and appreciation of all forms of diversity.

• A degree or diploma as a Registered Nurse from an accredited school of nursing, college, or university.
• One (1) year of hands‑on patient care nursing experience in a hospital or clinic setting.

Note: If applicable, equivalent combinations of education and experience may be considered, provided they are directly related to the functions and responsibilities of the job.

• Current Registered Nurse license in good standing from the Arizona Board of Nursing.
• Current Basic Life Support (BLS) certification for health care providers.
• Level I fingerprint clearance card — current, valid, and in good standing (or must apply within seven working days after beginning employment).
• Reliable transportation that can meet operational reassignments; if driving during work hours, a valid driver’s license and compliance with Arizona vehicle insurance requirements are required.

• Three (3) years of hands‑on patient care nursing experience in a hospital or clinic setting.
• Three (3) to five (5) years of nursing experience in an…