CARE COORDINATOR RN

Location/Department: Physician's Center - Primary Care 80 hours per pay period - benefit eligible Job Summary: The Care Coordinator works in collaboration & continuous partnership with chronically ill or “high-risk” patients & their families, clinic/hospital providers & staff, & community healthcare resources in a team approach to: promote timely access to appropriate care; increase utilization of preventative care; reduce ED utilization & hospital readmissions; increase comprehension through culturally – & linguistically – appropriate education; create & promote adherence to a care plan, developed in coordination with the patient & the patient/family; increase continuity of care by managing relationships with tertiary care providers, transitions-in-care & referrals; increase patients’ ability for self-management & shared decision-making; provide medication reconciliation; connect patients to relevant community resources; with a goal of enhancing patient & family health & well-being, increasing patient satisfaction & reducing costs. Supervisory Responsibilities: None Duties/Responsibilities: Uses only approved abbreviations. Understands patient safety goals & actions taken. Uses 2 patient identifiers before giving treatments, demonstrates process. Understands read back of verbal orders/critical lab values & can state process. Understands procedure to clarify physician orders. Uses standing orders when indicated. Accurately calls report to MD as warranted by condition; reports to other providers as needed. Reports sentinel events or adverse drug reactions or incidents as warranted. Uses final verification before invasive procedures & can verbalize correct process & documents in EHR. Reassesses patient in response to changes in condition after intervention as needed & documents in EHR. Attend all Care Coordinator training webinars & meetings. Provide feedback for the improvement of the Care Coordination program. Assist with the identification of “high-risk” patients (the chronically ill & those with special health care needs). Work with patients to plan & monitor care; assess patient & family’s unmet health & social needs; develop a care plan with the patient, family & providers (emergency plan, medical summary, & ongoing action plan as appropriate); monitor adherence to care plans, evaluate effectiveness, monitor patient progress in a timely way & facilitate changes as needed; create ongoing processes for patients & families to determine level of care coordination support they desire at any given point in time. Serve as the contact-point, advocate & informational resource for patient, family, payers & community resources. Facilitate patient access to appropriate medical & specialty providers. Educate patient & family about relevant community resources. Cultivate & support primary care & subspecialty co-management with timely communication, inquiry, follow-up, & integration of information into the care plan regarding transitions-in-care & referrals. Facilitate & attend meetings between patient, family, care team, payers & community resources as needed. Required Skills/Abilities: Demonstrates a positive attitude & respectful, professional customer service. Acknowledges patient’s rights on confidentiality issues, maintains patient confidentiality at all times, & follows HIPAA guidelines & regulations. Proactively acts as patient advocate, responding with empathy & respect to resolve patient & family concerns, & recognizes opportunities for improvement to meeting patient concerns. Proactively continues to educate self on providing quality care & improving professional skills. Education and Experience: Minimum Associates degree in nursing, Bachelor’s degree preferred Minimum of 2 years relevant work experience required Must be licensed as a Registered Nurse in the state of Indiana Physical Requirements: Frequent walking, standing, pushing, pulling, stooping, kneeling, reaching, talking, & use of hands Occasionally may need to lift up to 25 lbs Qualifications Education Preferred Bachelors degree in Nursing or better in Nursing. Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor. #J-18808-Ljbffr Mmhealth