RN Care Coordinator Job Listing at Highland Hospital in Rochester, NY (Job ID 711637)

Description

A.    Clinical Practice Responsibilities:1.    Leads interdisciplinary care planning:

1. 1. Completes comprehensive assessment of patient/family needs and capabilities to support care needs post hospitalization.
   2. Identifies factors critical to achieving required outcomes for discharge, post-hospitalization recovery and health maintenance.
   3. Ensures interdisciplinary medical record documentation of patient progress toward goals for all patients followed
   4. Disease specific management to reduce readmissions.
   5. Identifies goals and usual patterns of care for specific groups of patients.
   6. Uses data to develop and implement strategies that reduce length of stay and resource utilization, and facilitate patient flow.
2. Collaborates in patient care planning process by:
   1. Participation in daily health team rounds.
   2. Facilitating discharge plans, including acquisition of medications, supplies and equipment.
   3. Identifying discharge barriers and working toward overcoming them to achieve timely and safe discharge.
   4. Identifies community resources and Primary Care Management to assure handoff of patient information.
   5. Utilizes the Longitudinal Plan of Care to access patient information and update information based on hospitalization.
   6. Assure completion of Community Agency Choice letters and Advance Directives.
   7. Facilitating timely referrals to Community Home Health Agencies and facilities.
3. Educates nursing staff in matters related to disease-specific patient education compliance. 

1. Self/Professional Development:

1. Maintains current knowledge base in nursing practice

1. Identifies knowledge and skill needs through self-assessment, peer and supervisor review.
2. Participates in ongoing educational pursuits to maintain and improve competence.

1. Role models collaborative practice by mentoring and educating all health care providers in all aspects of care coordination.
2. Coordinates and provides formal and informal care coordination or clinical inservices based on needs assessment.
3. Demonstrates initiative in obtaining and sharing information about professional issues.
4. Participates in the orientation of new staff and providers.
5. Provides clinical experiences for Nursing Students.

1. Participates in Supporting Hospital/Department Goals:
   1. 1. 1. Aware of department performance improvement goals

            and participates in data collection and reporting.

1. 1. 1. 1. Uses data to develop and implement strategies to reduce

             length of stay and improve patient flow.3.         As requested, participates in / leads clinical practice and             hospital projects and committee work  4.       Attends Unit Quality Meetings.Safety:

1. Is aware of emergency procedures, fire and safety guidelines for assigned area; takes responsibility to notify appropriate person(s) of any hazards.
2. Maintains safe environment by following all written standards and appropriately using reporting mechanisms.
3. Demonstrates understanding of age-related patient needs from neonate to geriatric age range, as appropriate to role.

4.    Demonstrates proactive action to avoid potential risk situations.

1. Supports and is accountable for safe patient care.
2. Assumes other duties as assigned.

Requirements

1. Education – Associates Degree in Nursing required, BSN preferred

 

1. Experience – 2 plus years current acute care nursing experience

 

1. License/Certification Required – Licensed to practice nursing in New York State; PRI certification a plus

 

1. Skills – Proficiency in Microsoft Office, spreadsheet creation and management, data entry and report writing

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