In celebration of National Nurses Week and this year’s theme, “Nurses Make the Difference,” we’re highlighting one of our nurse coaches and her impact on members in the home every day. She shares her journey to becoming a nurse, the members who have touched their life, and what she says is the most rewarding part of being a nurse coach.

Meet Nurse Coach Lori

Nurse coach Lori says she knew since childhood that she would be a nurse one day. Her aunt, who was a nurse, was one of her biggest role models and she was inspired by her compassion and desire to help others. “I’ve always loved helping people and I live by the golden rule: treat people the way you want to be treated,” according to Lori. “I chose nursing as a career because the profession is so diverse and there’s a lot you can do that aligns with what you’re passionate about.”

After working as a nurse coach for a health insurance company, Lori wanted to find a role where she could have an even greater impact on members’ return home and ensure they have a successful recovery. So when she learned about the nurse coach Readmissions Management opportunity at CareCentrix, she knew that it was more aligned with what she wanted to do as a nurse, which was to help members recover at home and stay out of the hospital.

Once Lori was hired, she loved the work, but she quickly discovered that one of the hardest parts of her job was engaging with the members after they were discharged from the hospital.

“When they come back home, they’re often hesitant to talk to us but these are often the members who need us the most,” she says. “Sometimes they live alone and we’re the only person they have for support. That’s why we make a concerted effort to establish and foster trusted relationships with them. At the end of the day, when we have these breakthroughs, there is understanding and a greater appreciation that we’re there for them.”

Care When it Matters Most

No two days are ever the same for a CareCentrix nurse coach. With members who are discharged with a variety of diagnoses, medications, care plans, and plenty of questions, the nurse coach team is frequently adapting to the members’ needs.

Once nurse coaches engage with members, they’re responsible for monitoring their recovery progress and coordinating resources that address unmet social determinants of health (SDoH) needs such as meals, transportation, and emotional support.

“The best part of my job is that I get to spend time getting to know the members, and motivating and empowering them to recover at home,” Lori says. “On a daily basis, I answer questions, help coordinate care and establish trust, which starts with knowing they can contact us anytime they need something.”

One of those members was Nate*, a member who Lori assisted last year. Nate always had a clean bill of health, but he was suddenly admitted to the hospital for shortness of breath and fatigue. He had not been feeling well for some time, and it had become increasingly difficult for him to do the activities he enjoyed.

During his hospital stay, he was diagnosed with a rare condition. With a young family at home, staring down a new diagnosis, thinking about what lay ahead, and how his life would change was overwhelming. “He worried about his condition worsening and he wanted nothing more than to be present in his family’s life,” Lori says.

By helping the family understand Nate’s condition and providing a calm and listening ear, Lori was the support system the family so desperately needed. “The family was very appreciative of my support and Nate told me he didn’t know what he would do without me there to listen and guide him,” she recalls.

Making a Difference with Early Engagement and Unparalleled Access

At CareCentrix, nurse coaches reach out to members within two to three days of discharge. Additionally, members are provided with their nurse coach’s direct line to ask questions or get support. The amount of time members can receive services is tailored to their individual needs, but they can be supported for up to 90 days.

With a unique combination of early outreach, ongoing engagement, and whole-person care, the nurse coaching program has a positive impact on members’ transition home. “We are member-centric, so we look at the member holistically, putting their goals at the forefront of care, and motivating and empowering them,” Lori says.

While their responsibilities are as unique as their members, there is one common thread in how they deliver care

Learn more about our Readmissions Management solution which helps members overcome some of the barriers during their transition home.


*Names have been changed.

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