Medical - RN Care Partner

Marana Health is seeking an RN Care Partner to join the Medical team at the Marana Main Health Center, located in the heart of Marana, AZ.

The RN Care Partner is responsible for providing clinical care coordination and patient support services to improve patient outcomes, enhance continuity of care, and reduce barriers to accessing healthcare services.. Working collaboratively with the clinical team, the RN Care Partner supports chronic disease management, hospital follow-up, preventive care, patient education, and care transtions. This role promotes patient-centered care while supporting organizonal quality, access, and population health goals.

Marana Health is a Federally Qualified Community Health Center (FQHC), with 11 sites in Tucson and Pima County.

Our mission is to improve our community by providing exceptional, whole-person healthcare.

• Associate degree in Nursing
• Valid Arizona State License as a Registered Nurse
• 2 years’ nursing experience
• Basic Life Support (BLS) Certification
• Fingerprint Clearance Card through the Arizona Department of Public Safety

• Bachelor’s degree in Nursing
• Case Management experienceID
• Bilingual (English/Spanish)
• Certified Diabetes Educator (CDE from NCBDE) or Board Certified-Advanced

Diabetes Management (BC-ADM from AADE) credential

Does not direct or supervise others.

• Knowledge of nursing principles, care coordination, and patient techniques for all age groups including neonates, infants, children, adolescents, adults, and geriatrics.
• Competent with patient triage in a primary care setting with strong assessment, critical thinking, and clinical decision-making skills.
• Knowledge of quality metrics, population health, and value-based care principles
• Computer proficient in including Microsoft Office applications.
• Knowledge of patient appointment scheduling.
• Excellent customer service, organizational, and communication skills with emphasis on responsiveness, building trust, mutual respect, and courtesy.
• Demonstrates cultural competence and effective communication and interpersonal skills with diverse patient populations.

• Coordinates patient care activities across the continuum of care.
• Collaborates with clinicians and interdisciplinary staff (internal and external) to identify and resolve concerns.
• Provides telephonic and in-person patient outreach, education, and follow-up.
• Provides counseling and coordinates treatment plans for patients.
• Identifies and addresses barriers and assists patients in accessing resources to achieve their personal health goals.
• Supports hospital discharge follow-up, emergency department follow-up, and transition of care management.
• Monitors and manages high-risk patient populations to improve quality outcomes and reduce avoidable utilization.
• Engages with patients and families to determine and facilitate the level of case management support required.
• Conducts patient telephone and in-person triage to assist in determining the appropriate level of care needed.
• Administers injectable medications per clinician’s order to medical and behavioral health patients
• Performs wound care per clinician order
• Guides transition of care to achieve individualized patient and family quality outcomes.
• Evaluates and monitors the effectiveness of the care plan and initiates necessary changes.
• Serves as a patient advocate and liaison between patient, family, and healthcare team.
• Documents care plan and interventions.
• Ensures patient-centered coordination to facilitate the provision of comprehensive health promotion and chronic…