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Salary: USD 65,000 - 75,000 / annual
Bluestone Physician Services is seeking a Care Coordinator, RN to join their multidisciplinary care teams serving seniors and disabled individuals living with complex, chronic conditions. This hybrid role is based in the St. Paul/Roseville area and involves 50–70% in-person community visits to members' homes and assisted living facilities, with 30–50% remote work from home.
You will manage a caseload of MSHO/MSC+ members within your assigned geographic area, coordinating their healthcare journey and connecting them with vital medical care, waiver services, and community resources. Bluestone's evidence-based care model has demonstrated significant outcomes: their patients experience 21% fewer ER visits, 36% fewer hospitalizations, and 41% fewer hospital readmissions compared to similar populations.
Key responsibilities include conducting face-to-face visits, managing Elderly Waiver requirements, performing annual assessments (including Personal Care Assistance assessments), developing individualized care plans, connecting members with community and state resources, ensuring safe transitions of care, and collaborating with medical teams to meet health care quality measures and value-based goals. You'll complete required documentation and help members remain safely in their homes and communities.
Bluestone offers comprehensive support including a 6-month onboarding program, dedicated preceptor support, ongoing mentoring and coaching, continuing education, and collaborative management. The schedule is full-time, Monday–Thursday 8:00 AM–5:00 PM and Friday 8:00 AM–3:00 PM, with no evenings, weekends, holidays, or on-call requirements.
Benefits include health, dental, and vision insurance; company-paid life insurance and disability coverage; HSA with employer contribution; 401(k) with 4% matching; 9 paid holidays plus 1 floating holiday; 3 weeks PTO; mileage reimbursement; and company-provided cell phone, laptop, and scrubs.
**Requirements:**
- Minnesota Registered Nurse license OR current Minnesota Licensed Social Worker (LSW, LMSW, LISW, or LICSW). New graduates encouraged to apply.
- One or more years of experience working with geriatric or certified disabled populations in case management, care coordination, home care, group homes, nursing homes, TCU, or assisted living settings (preferred).
- Valid driver's license required.
- Ability to work independently with access to a private, compliant home office space.
- Strong problem-solving, verbal communication, and interpersonal skills.
- Demonstrated ability to read, write, speak, and understand English.
- Appreciation for working with diverse populations and compatibility with Bluestone's mission.