ED U-Turn Care Coordinator
The ED U-Turn Care Coordinator reports to the Care Transitions and Management Dept. Manager and the Director of Population Health Operations for Adventist Healthcare. This position also consults with members of the Patient Care Services Leadership and Hospital Leadership staff as appropriate.
The ED U-Turn Care Coordinator works in the Emergency Department and collaborates with the patients and other healthcare providers both within the organization and in the community to facilitate patient access to those health and social services which enhance the client's health, well-being and his/her ability to adhere to the prescribed medical treatment regimen in the most efficient and cost effective manner possible. The ED U-Turn Care Coordinator works with a multidisciplinary team to identify patients who have frequent ED visits, are potential 30-day readmissions, and/or are at increased risk for readmission/revisit. Upon identification of such patients, the ED U-Turn Care Coordinator assesses and provides the services necessary to discharge the patient from the ED both safely and efficiently or admit the patient to the Observation unit, when appropriate. The ED U-Turn Care Coordinator works with providers to develop care plans that allow the patient to successfully manage their health outside of the ED. The ED U-Turn Care Coordinator works in conjunction with Care Transitions and Management team to expand access to outpatient services and to support its mission of reducing readmissions through improving transitions of care.
Principle Duties and Responsibilities:
Assess, plan, implement, coordinate, monitor and evaluate healthcare services to meet an individual patients specific health care needs in a cost-effective manner. Collaborates with client, physicians, and other providers to develop a comprehensive plan of care.
Coordinate patient care with patient, family, staff, physicians, and ancillary/community services to promote quality and cost-efficient care.
Use the nursing process to provide case management services to an assigned caseload.
Complete initial client/family assessments and problem lists. Accurately identify and prioritize patient problems using critical thinking skills. Effectively communicate care plans and other client-related activities both verbally and in writing to appropriate personnel and agencies. Utilize clinical skills and assessments to work autonomously in outpatient, community settings and to communicate with physicians and other providers re: alterations in the plan of care. Demonstrate the ability to use teaching, learning, and counseling skills.
Act as a client advocate for the development of community resources. Maintain a directory of available services by geographical area and updates others about new services. Consult with others to identify potential community resources for resolving client health, psychosocial, or financial problems.
Function as liaison to external agencies and relays information to others which may impact care and/or services of clients. Demonstrate the knowledge and skills necessary to provide services appropriate to the age of the patient. Develop and initiate cost saving strategies to achieve decreases in patient resource utilization.
Collaborate with regional hospitals. Identifies vulnerable high risk ED and inpatients. Educate
hospital team members and patients about available network services. Attend hospital multidisciplinary meetings to formulate care plans for high utilizing patients. Improve access to mental health resources upon discharge.
Must have a BSN in Nursing or bachelors degree in Social Work (Masters preferred for a social work degree)
Current MD RN licensure/LCSW-C
3-5 years experience in acute care setting
Strong assessment skills
Ability to prioritize multiple tasks
Ability to interact with various members of health care team
Ability to advocate for patient/family
Good verbal and written communication skills
Computer proficiency in e-mail, Microsoft suite applications (Windows, Excel, Word, Outlook), and the Internet
Evidence of at least one year of previous experience as a nurse case manager or discharge planner with clients in the clinical specialty area desirable
Evidence of a high level of skill in assessment, identification of problems, care planning, identification and development of community resources, and patient/family teaching required
Ability to work effectively with others to accomplish organizational goals and to identify and resolve problems
This is a full time days.
Tobacco use is a well-recognized preventable cause of death in the United States and an important public health issue. In order to promote and maintain a healthy work environment, We will not hire applicants for employment who either state that they are nicotine users or who test positive for nicotine use.
We will withdraw offers of employment to applicants who test positive for Cotinine (nicotine). Those testing positive for cotinine are given the opportunity to re-apply in 90 days, if they can truthfully attest that they have not used any nicotine products in the past ninety (90) days and successfully pass follow-up testing.
Equal Employment Opportunity
We are an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or protected veteran status.
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