RN Health Coach (West Broward)

RN Health CoachRN Health Coach is a purposeful, result oriented structured client interaction that is provided by an RN for the purpose of promoting achievement of client goals. RN Health Coach promote and facilitate growth, healing and wellbeing of the whole person using coaching principles and healing modalities that integrate body-mind-emotion-spirit-environment. Health Coaching is a skillful use of evidence based, conversations, clinical interventions and strategies to safely engage clients who have Chronic conditions or at moderate to high risk for developing them. RN Health Coach focuses on disease process management and education intended to reduce unnecessary hospital admissions through the patient's understanding of their condition as well as working closely with the patients' primary care physician to detect an exacerbation with sufficient time to avoid an ER visit.Essential Duties and ResponsibilitiesCompletes RN Health Coach Evaluation which includes a systematic assessment of patient's functional, psychosocial needs, fall precautions, safety, environmental, nutritional, Medication reconciliation, Cognitive, and medical history, and Point of Care testingIdentifying client readiness to changeIdentifying opportunities and issues related to the client's growthWith input from patient/care giver establish centered goals and outcomes to formulate and implement plan of careEvaluate effectiveness of Care Plan and make necessary adjustmentsPlan and structure the coaching interactionsPrepares RN Health Coach and progress notes, and coordination of services on a timely basisCoordinate PCP follow ups (call to help ensure they made their appointments) or set an appointment from the patient's homeCommunicate directly with PCP and/or specialists regarding any problems, or changes in therapy and/or medicationsProvides for the emotional and physical comfort and safety of clients, taking into consideration their rights and cultural backgroundsProviding patient education, monitoring of health needs, and coordinating of community resourcesNotify physician and supervisor of unusual reactions and/or changes in client's conditionParticipate in case conferences, team meetings, staff meetings and Performance Improvement activities as assignedFacilitating patient empowerment and quality of life by promoting educated, independent patient choice on all aspects of careIdentifying opportunities for health promotion and illness preventionHelping clients achieve wellness and autonomyImproving beneficiary safety and satisfactionShow compassion and empathy and take a genuine interest in the patient and his/her well-beingAdhere to all policies and procedures including but not limited to the HIPAA Privacy ruleDocumentation on EMR proficient and timely mannerPrepares clients' discharge by reviewing and amplifying discharge plans; coordinating discharge and post-discharge requirements; orienting and training family members on post discharge care including providing available information on resources available to the patientEnsure that all coaching interactions are respectful and non-judgmentalParticipation in Genuine at Home sponsored in-service trainingAdheres to all policies and procedures including HIPAAMaintains professional licensure and other requirementsPerforms other duties as assignedKnowledge, Skills and AbilitiesDocumentation SkillsEMR proficiencyAnalyzing InformationCritical Thinking SkillsDecision MakingResearch SkillsVerbal and written communication proficiencyPeople SkillsConflict resolutionPeople ManagementIntegrity, compassionBilingual: Spanish and EnglishMinimum Education and ExperienceCurrent Registered Nurse (RN) license in the State of Florida; Bachelor's required2+ years of nursing experience in case management, disease management, home or facility settingsExperience managing adult, Medicare/Medicaid, and medically complex or high-risk patient populationsStrong clinical assessment skills with a focus on chronic condition management and care planningExperience in care coordination and transitions of care, including post-discharge follow-up and readmission preventionExperience with patient education, health coaching, and holistic care to drive engagement and self-managementExperience working collaboratively with interdisciplinary teams, including PCPs and specialistsProficient in MS Office Suite to include Word, Excel, Notes, OutlookJob LocationHybrid Remote/Field roleLocal travel required throughout Miami Dade – West Broward