**Description** **Our team is growing! Pardee BlueMD, a part of the Pardee UNC Health Care organization, is a primary care physician practice network organized as a Federally Qualified Health Center (FQHC). Our full-time positions offer a range of benefits, including medical, vision and dental insurance, retirement savings, paid time off, and more. Come be happy with Pardee!** Summary: The Ambulatory Care RN is responsible for patient outreach and care coordination in the ambulatory practice setting. Identifies barriers to care plan compliance and provides appropriate education and resources. Works collaboratively with the care team to achieve high quality, low cost outcomes for patient populations. Consistently achieves established productivity targets. Appropriately documents in the medical record to support patient visits and care gap closure or exclusions. Responsibilities: • Under provider supervision, coordinates Medicare visits including Welcome to Medicare, Medicare transition of care visits, and Annual Wellness Visits. Collaborates with Quality Metrics staff to identify and correct patient care gaps. Examples include immunization and routine screening needs, as well as annual wellness visits due. Maintains weekly reports of visits scheduled and completed and consistently achieves productivity targets. • Serves as a patient advocate, supporting shared decision-making. Identifies, coordinates, and helps to align patient care and community resources to facilitate patient care transitions and prevent hospital readmissions and Emergency Department visits. Facilitates and completes all necessary applications and paper work to access services. • Completes documentation within 72 hours of visit. Makes suggestions for improvements based on trends and changes in practice. Makes recommendations that have a positive effect on overall patient care. • Identifies personal educational needs and reviews with Director to achieve educational goals. Accesses information from available professional or clinical resources. Shares knowledge gained through participation in educational activities with other associates. Submits a record of participation in all professional educational activities on an ongoing basis. • Develops and maintains knowledge of coding and reimbursement practices and documents correctly in the electronic medical record. Performs other duties as assigned by management. **Other information:** Qualifications Required • Currently licensed as a Registered Nurse by the NC Board of Nursing to practice as a RN in the state of North Carolina or compact state. • Three years of recent clinical experience in an acute care setting/home health/ or long-term care required. Preferred • Experience in care management **Job Details** Legal Employer: Pardee - HCHC Entity: Pardee UNC Health Care Organization Unit: Blue MD Administration Work Type: Full Time Standard Hours Per Week: 40.00 Work Assignment Type: Onsite Work Schedule: Day Job Location of Job: DR PARK Exempt From Overtime: Exempt: No Qualified applicants will be considered without regard to their race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.