Registered Nurse Care Coordinator (Chronic Disease)

Join us at EACH  
For over 50 years, EACH has been dedicated to enhancing lives and fostering stronger communities through our health and support services. Our workforce comprises compassionate individuals ready to offer a wide range of services tailored to meet the unique needs of individuals from all walks of life. Join us in our mission and together, let's create meaningful change. 

We are a 2024 Circle Back Initiative Employer - we commit to respond to every applicant .   

About The Team

The Chronic Disease Management Services sit as part of Clinical and Complex Care Services within EACH’s Outer East Primary Health Area. The Pathways++ Program is a collaborative initiative in the Eastern region that provides integrated care for chronic condition management. Partnering with Eastern Health Hospital Admission Risk Program (HARP), Eastern Health Community Health (EHCH) and EACH, the program aims to decrease hospitalisations, increase HARP capacity and improve health outcomes. Through patient centric care coordination, individuals are empowered to manage their health independently, enhancing their quality of life and facilitating early detection of health deterioration.

As a Chronic Disease Registered Nurse, you will play a vital role in providing specialised care to clients living with chronic conditions. Your primary responsibility will be to provide tailored care coordination, chronic disease education and monitoring, early detection and escalation of deterioration as well as close collaboration with external stakeholders to ensure seamless integration of care. The Chronic Disease Registered Nurse will provide home visits and face to face consultations to ensure clients with complex chronic conditions experience an improved quality of life, enhanced understanding of their chronic condition including increased medication adherence and a lowered rate of avoidable hospital admissions. They will participate and lead the support for people to access Primary Health Care, both internal to EACH’s range of services and to external community GP’s and other specialist health services. They will take on a health coaching role for their clients within this service providing education and support to improve health literacy and self - management.

Job Description

• Part-time max term until 30 June 2025
• Ferntree Gully  
• Classification CN4

The Chronic Disease Registered Nurse Care Coordinator in the Pathways++ program provides tailored, person-centred care for patients with complex and chronic conditions, ensuring EACH delivers exceptional care consistently.

What You’ll Be Doing:

• Conduct comprehensive health assessments and collaborate with clients to understand their conditions, treatments, and active management strategies.
• Identify and prioritise health issues impacting patients.
• Support patients in overcoming barriers to engaging with health professionals or services.
• Assist clients in setting goals and developing care plans to address their health issues.
• Initiate referrals to appropriate health professionals and services, including social prescribing.
• Participate in clinical supervision and engage with key stakeholders.
• Ensure customer-focused, high-quality services that comply with Quality and Compliance standards and best practice care.
• Maintain accurate customer records and complete documentation timely and accurately.
• Adhere to professional and ethical standards.
• Foster a team culture aligned with EACH values and behaviours.
• Contribute to continuous program development and quality improvements.
• Represent the service at internal and external forums, meetings, and networking events.
• Attend performance meetings with relevant funders to discuss performance and compliance when requested.

To view a copy of the full Position Description, click here . Alternatively, for more information please contact Trechelle Herington (Senior Project Manager and Team Lead) on [email protected]

What's In It For You?

EACH is dedicated to helping our team members thrive. Here’s how we support you to be your best:

• Flexible Work Arrangements: Enjoy a positive work-life balance with work schedules that adapt to your needs.
• Dynamic Team Culture: Be part of an engaging, inclusive, and supportive team that meets regularly and stays connected through a dedicated chat page for daily support.
• Generous Salary Packaging: Benefit from up to $15,900 tax-free income per year through Not-for-Profit Salary Packaging.
• Extra Tax-Free Income: Enjoy up to $2,650 additional tax-free money for meals and entertainment.
• Career Progression : Explore opportunities for internal career advancement across QLD, NSW, ACT, and VIC.
• Comprehensive Support : Access our Employee Assistance Program for you and your immediate family members, offering a wide range of support services.
• Continuous Development: Take advantage of opportunities for ongoing growth and development to advance your career.

About You  

We’re looking for someone who brings a wealth of expertise and passion to our team. Here’s what makes you the perfect fit:

• Clinical Expertise: You excel in managing complex clinical caseloads with a patient-centred approach, delivering evidence based care.
• Versatile Skill Set: Your exceptional skills span a wide range of clinical assessments, treatments, interventions, and patient education in chronic disease management.
• Holistic Health Advocate: You understand and are committed to the principles and practices of community health, primary health, and the social model of health.
• Cultural Competence: You have a demonstrated capacity to work effectively with people from diverse backgrounds, including culturally and linguistically diverse communities.
• Diverse Clinical Experience: Your experience spans various clinical settings, including community based settings, showcasing your adaptability and breadth of knowledge.
• Chronic Disease Specialist: You bring proven experience and skills in providing chronic disease management services, making a significant impact on patient outcomes.
• Relationship Builder: You have a natural ability to develop and nurture positive, ongoing relationships with a wide range of stakeholders.
• Communication Excellence: Your excellent communication skills make you an effective and compassionate caregiver.
• Independent Worker: You thrive in an autonomous environment, demonstrating strong self-motivation and initiative.

Qualifications

• Bachelor of Applied Science (Nursing), or equivalent
• Registered Nurse, Division 1 with current registration to practice with AHPRA
• Minimum 4 years nursing experience
• Completion of a Criminal History Check and Employee Working With Children Check (or State equivalent) prior to commencement of employment and as required by legislation and policy during employment, as well as a duty to disclose relevant information that may arise after employment has commenced

Additional Information

Applications close: Tuesday 2nd July

** Please note that applications will be reviewed as they are received. Interviews may take place during the advertising period - so don't miss out and apply today!** 

Next Steps in the Hiring Process 

Thank you for your interest in joining EACH! To learn more about next steps, please check out our Hiring Process Guide.

EACH Commitments

At EACH, we prioritize treating every individual with dignity and respect, regardless of their background, ability, or identity. We actively encourage applications from diverse backgrounds and those with lived experiences.

EACH is committed to creating a culturally safe environment that values and supports Aboriginal & Torres Strait Islander people(s), recognizing and respecting their unique culture and contribution to our communities. We strongly encourage applications from Aboriginal and Torres Strait Islander People. For further information regarding our commitment please see our

As a child-safe organisation, EACH prioritizes child safety and well-being by creating a secure environment for children and implementing effective organisational structures, policies, and procedures