Position:            RN Care Coordinator TPC90018
Department:      Health and Wellness

Summary: The RN Care Coordinator will work closely with private hospitals on the Westside of Los Angeles County to assist them in linking homeless, high utilizers of emergency room and inpatient services to appropriate community-based primary care, housing and other resources. This position also works as part of the agency’s multi-disciplinary care team to provide medical services to individuals living on the streets, in our interim housing facilities and in permanent supportive housing.

Schedule: Wednesday through Saturday from 12 pm to 10 pm

Under the supervision of the Director of Community Nursing, the RN Care Coordinator will:
  1. Utilizing a harm reduction model, provide health services to homeless individuals with acute and chronic medical conditions in various settings.
  2. Build effective working relationships with Westside hospital patient navigators and other medical center staff and coordinate directly with the hospitals to connect homeless patients to appropriate services across LA County, including referrals to The People Concern when appropriate.
  3. Provide medical screening, assessment, insurance and benefits verification for referrals to the agency from hospitals or other community partners to insure that we can provide the appropriate level of care.
  4. Coordinate with primary care providers’ medical teams to ensure that clients’ medical needs are met.
  5. Provide medical triage, wound care, medication reconciliation, care coordination and nursing care within the California State Board of Registered Nursing scope of practice.
  6. Provide health education to clients, staff and community partners.
  7. Work as a team with paraprofessional staff to provide home visits and arrange for home health resources for housed clients.
  8. Promote patients’ independence by establishing patient care goals, teaching patients to understand their medical condition, medications, and support self-care skills. 
  9. Assure quality of care by adhering to therapeutic standards; measure health outcomes against patient care goals and standards; make or recommend necessary adjustments; follow nursing and agency philosophies and standards of care set by the California State Board of Registered Nursing, state nurse practice act, and other governing agency regulations.
  10. Assist in resolving patient care issues and needs by utilizing multidisciplinary team strategies.
  11. Maintain continuity among nursing team by documenting and communicating actions, irregularities, and continuing needs.
  12. Maintain strict privacy practices.
  13. Assist with maintaining nursing supplies inventory by checking stock to determine inventory level; anticipate needed supplies; place and expedite orders for supplies; verify receipt of supplies; use equipment and supplies as needed to accomplish job results.
  14. Assist with medical policy development and implementation.
  15. Work directly with and provide education on harm reduction nursing and working with vulnerable populations for nursing students completing clinical rotations at The People Concern.
  16. Maintain professional and technical knowledge by attending educational workshops, reviewing professional publications, establishing personal networks, participating in professional societies and maintaining license requirements.
  17. Maintain a cooperative relationship among care teams by communicating information, responding to requests, building rapport, participating in team problem-solving methods.
  18. Maintain a safe and clean working environment.
  19. Other duties as assigned.

  • Registered Nurse degree from an accredited nursing program.
  • Current nursing license.
  • One year post-degree nursing experience.
  • Ability to work well as part of an interdisciplinary team.
  • Excellent verbal and written communication skills.
  • Excellent charting/documentation skills.
  • Passion for and commitment to working with underserved and indigent population.
  • Ability to work well with culturally diverse clientele, including LGBTQ individuals and those living with disabilities, mental illness and substance use disorders.
  • Skilled in non-violent crisis intervention
  • Skilled in data collection
  • Ability to self-motivate, multi-task and be flexible in a fast paced environment
  • Strong working knowledge of and ability to do all basic functions in MS Office Suite (Word, Excel, PowerPoint, Outlook, etc.).
  • Valid CA Driver’s License

Department: Wellness Center
This is a non-management position
This is a full time position

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