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RN Care Coordinator - Richwood Primary Care

Job Type: Regular Scheduled Hours: 40 Job Summary: Reports to the RN Manager of Care Coordination, the RN Care Coordinator (OCC) works collaboratively with providers, interdisciplinary staff, and clinical associates, in person and telephonically, at any/all SEP offices to support patients with chronic conditions and/or complex needs according to guidelines established by SEP and other clinical programs such as PCF etc. Facilitates effective communication, coordinates services, address barriers, and provides education and guidance for patients related to current health concerns. DIMENSIONS: A RN Care Coordinator- Office Care Coordinator works in person and telephonically as a member of the interdisciplinary team. A RN Care Coordinator- Office Care Coordinator understands and adheres to established best practice care management standards of care. A RN Care Coordinator- Office Care Coordinator understands and coordinates care using evidence based clinical guidelines for chronic disease management. Job Description: Job Title: SEP - RN Care Coordinator (OCC) DUTIES AND RESPONSIBILITES: Documents in chart appropriately utilizing care management documentation. Provides patient care through collaborating with patients, providing education and clear direction to the patient and address patient concerns regarding care. The RN engages in critical thinking to meet patient needs. Support Chronic Disease Management and Patient Care Needs: - Identify patients with chronic disease, rising risk concerns, social, financial, or educational needs for care management services. - Respond to provider referrals and/or identify patients who meet established criteria for care management (e.g. HgA1c > 8, elevated LDL and/or blood pressure, Mental Health Integration referral, complex needs) - Evaluate and collaborate with patients’ and families to determine readiness to change and resources for support. - Monitor compliance with plan of care and problem solve barriers to patient self-management. - Provide support for patient and family issues, resource needs, and answering general healthcare questions. - Do ADL assessment and home safety assessments based on patient interview. - Identify and place order for services such as HH when patient has identified need - Utilize teach back method for pts who have no medical necessity to justify home health. - Assess need and provide basic diabetic teaching (glucose meter testing, etc.) - Assess need and obtain required order for patient to receive disease management teaching or counseling (MD referral required for billing) - Document RN Care Coordinator interventions in Epic within care management documentation. - Refer non-nursing functions, such as assisting patients with completion of Medicaid, disability, pharmacy program or other eligibility applications, and scheduling appointments to designated resources in the region. - Coordinate with care managers in other settings as appropriate. - Carry out assessments and make decisions on his or her own before seeking the support of a supervisor. - Assist providers, patients, and families with Advance Care Planning - Explain results from screening based on protocol and guidelines. - The RN is expected to perform medication reconciliation for each patient on their panel. Provides ongoing management for chronic conditions, working with patients to meet healthcare goals per cadence expectations. Patient Education: - Provide education and pre-printed, SEP approved educational materials as needed, or at provider or patient request - Work collaboratively with patients to assess needs and develop a patient education plan of care. - Answer clinical questions related to patients’ chronic health conditions. - Provide group education for established patients. - Must understand professional boundaries and appropriately refer diagnostic questions to MD. - Refer patients appropriately when needs for mental health, pharmacy, social work, respiratory therapy etc. are identified. - Work telephonically with patients as needed. Ensures complete and accurate information in the Electronic Health Record. Coordinate referrals to community resources (e.g. home health, Durable Medical Equipment, support groups) - Forward written physician orders for treatment - Assess patient for additional needs, develop nursing plan of care and contact physician for order-dependent items. Coordinate scheduling of appointments when support is needed for a multitude of disciplines. Maintains adequate level of resources for care coordination. OSHA and HIPAA compliance. Assists with completion of patient requests in a timely manner. Timely and accurate complete charting of all patient information. Other duties and responsibilities as assigned are complete in a timely and accurate manner. Maintain good working relationships communications with all interdisciplinary team members, management, and utilization review staff for coordination of care and care transitions. Work with providers, interdisciplinary staff, and office staff to identify appropriate patient population for advance care planning. Work directly with patient to educate, provide resources, and manage their disease processes. Manage and perform home visits with patients as needed if a component of care management expectations. Attend meetings as required. In office support for nursing tasks such as: PPD, IRIS Exams, CGM starts, etc. Collaborative communication with office staff to be available for warm hand offs and immediate patient needs. Assessment of medication affordability and assisting patients with identified needs. REQUIRED SKILLS AND KNOWLEDGE: Ability to manage and prioritize multiple tasks. Knowledge of electronic Health Records – (EPIC) Knowledge of Excel, Word, Outlook and PowerPoint and the ability to learn other computer skills as needed. Good organizational skills. Work professionally with doctors, hospital administration and management, SEP associates and the public. Organized, neat and self-motivated. Warm personality with concern for others. Excellent verbal and written communication skills. Excellent interpersonal skills. Ability to affect change. Ability to perform critical analysis. Self-directed Work well telephonically as well as face to face. Can work autonomously. Be familiar with motivational interviewing with patients. Positive attitude Quest for learning and excellence. OTHER REQUIRED SKILLS AND KNOWLEDGE: Previous Quality Assurance experience preferred EDUCATION: -Degree in nursing (ADN or higher) -Current Driver’s License in good standing and reliable and insured transportation LICENSES AND CERTIFICATIONS: -Kentucky Registered Nurse (RN) Compact License (or any RN compact license) required. -Care Management Certification preferred. YEARS OF EXPERIENCE: -Minimum of 3 years nursing experience or current care management position held within SEP Clinical Transformation. -Demonstrated knowledge of anatomy and physiology, pharmacology, etc. -Ambulatory and/or care management experience. FLSA Status: Non-Exempt Right Career. Right Here. If you have a passion for taking care of the community and are interested in Healthcare, you will take pride in the level of care we provide at St. Elizabeth. We take care of patients and each other. St. Elizabeth Physicians is an equal opportunity employer and will not discriminate on the basis of race, color, sex, religion, national origin, ancestry, disability, age or any other characteristic that is protected by state or federal law.

Staff Nurse - PICU - Mount Sinai Hospital - Per Diem Days

Mount Sinai Health System New York, NY

$82.63 / year

Description The (Per Diem) Clinical Nurse is a Registered Professional Nurse who provides safe, competent quality care based on nursing theory and research to a designated group of patients and significant others. Responsibilities Patient Care 1. Delivers patient care by incorporating the tenets of the professional practice model of Relationship Centered Care and through the application of the nursing process based upon theory, research, evidence-based practice, and approved organizational nursing standards. 2. Assesses and evaluates patient care needs and applies critical thinking skills in patient care management. 3. Integrates relevant assessment and intervention skills in the delivery of nursing care. 4. Collaborates with the interdisciplinary healthcare team in the development, implementation, and evaluation of the plan of care. 5. Prioritizes all aspects of patient care including teaching, rounding, coaching, and planning after hospital care and delegating to others as appropriate. 6. Educates patients and caregivers while anticipating needs and readiness to learn, about their plan of care, transition of care, promotion of health, and prevention of disease. 7. Communicates effectively and professionally with patients, family and all members of the Interdisciplinary Patient Care Team. 8. Manages assignments within the Care Delivery Model of Modified Primary Nursing and demonstrates allocation of material resources effectively. Patient Experience 1. Role models the tenets of Mount Sinai Relationship Centered Care (MSHRCC) through facilitation of the following actions including, but not limited to, Admission Welcome, Bedside shift Report, HELP, AM/PM Care, 5 Minute Sit Down, Purposeful Hourly Rounding, Medication Review, Discharge Wrap Up, and MD/RN Unit Collaboration. 2. Establishes and maintains a therapeutic relationship with the patient and family. 3. Uses evidence-based practices to increase understanding of patients perceptions of care. 4. Initiates service recovery for patients and family members who have concerns and escalates to Clinical Nurse Manager/Assistant Nurse Manager/Nursing Shift Manager or Patient Relations as needed. 5. Demonstrates caring, respect, compassion, empathy and active listening through dialogue, body language and actions. 6. Supports staff use of evidence-based practices to increase understanding of patients perceptions of care. 7. Conducts Purposeful Hourly Rounding (PHR) on assigned patients addressing the 4 Ps. Quality and Safety 1. Practices safe and efficient patient-centered care, identifying and escalating barriers and opportunities for improvement. 2. Demonstrates clinical skills and knowledge crucial to quality and safety in the patient population served. 3. Implements process improvement strategies based on institutional, evidence-based ensure and procedures. 4. Engages in formal and informal peer and institutional review processes. 5. Collaborates with interdisciplinary teams to create and implement quality improvement projects, evidence-based practice activities and nursing research studies. 6. Contributes to quality and safety practices and required compliance measures. 7. Implements principles of high reliability to identify and avoid high risk behaviors to provide a safe environment for patients. 8. Escalates potential safety hazards or gaps from best practice following institutional chain of command protocol. 9. Utilizes institutional information technology by documenting nursing practice to support quality and performance improvement initiatives. Operations 1. Performs charge nurse duties as assigned. 2. Coordinates with the Clinical Coordinator/Clinical Nurse Manager/Assistant Nurse Manager/Nursing Shift Manager to ensure supplies are appropriately utilized and inventory is sufficient for patient care. 3. Escalates material or staffing resource deficits to charge nurse, Clinical Nurse Manager/Assistant Nurse Manager or Nursing Shift Manager. 4. Demonstrates patient focused and cost effective approaches to patient care in terms of equipment, staff, supplies and all other resources. 5. Documents in an accurate and thorough manner in compliance with hospital, regulatory and legal requirements and standards of care. Professional Development 1. Contributes to the environment of care to support clinical colleagues, patients and their families and members of the healthcare team. 2. Advances clinical competence in nursing practice to progress from novice to expert. 3. Projects a professional image to colleagues and communicates with styles and methods that demonstrate caring, respect, compassion and empathy. 4. Incorporates ethical principles into decision making for patient and family. 5. Encourages and demonstrates a spirit of scholarship, inquiry, life-long learning and innovation for self and others. 6. Acquires knowledge and skills relative to the role, patient population, clinical specialty and local and/or global health community needs. 7. Participates in shared decision making through specialty practice councils, nursing department committees and unit initiatives. 8. Serves as a professional role model and preceptor for new staff and students. 9. Advances as a clinical leader through acting in the charge role, as a patient throughput facilitator and resource person for the unit/clinical service area. 10. Articulates the values of research and evidence-based practice and its application to nursing practice and the environment of care. 11. Contributes to the profession of nursing through participation in professional organizations. Qualifications Graduation from an accredited Nursing program. Bachelor?s Degree in Nursing. (BSN) Associate?s Degree in Nursing (ADN) RN who is matriculated in a BSN Program with a graduation date within the year. Any Associate?s Degree in Nursing (ADN) RN with Nursing experience must be approved by the CNO. Relevant clinical competence in area of nursing practice assigned; new graduates must possess current knowledge of the nursing process and its application Licensed as a registered nurse with current registration in New York State BLS and PALS from the American Heart Association 2 years of PICU experience Collective bargaining unit: NYSNA-MSH NYSNA at Mount Sinai Hospital , 795 - Pediatric ICU - MSH, Mount Sinai Hospital Employer Description Strength through Unity and Inclusion The Mount Sinai Health System is committed to fostering an environment where everyone can contribute to excellence. We share a common dedication to delivering outstanding patient care. When you join us, you become part of Mount Sinai’s unparalleled legacy of achievement, education, and innovation as we work together to transform healthcare. We encourage all team members to actively participate in creating a culture that ensures fair access to opportunities, promotes inclusive practices, and supports the success of every individual. At Mount Sinai, our leaders are committed to fostering a workplace where all employees feel valued, respected, and empowered to grow. We strive to create an environment where collaboration, fairness, and continuous learning drive positive change, improving the well-being of our staff, patients, and organization. Our leaders are expected to challenge outdated practices, promote a culture of respect, and work toward meaningful improvements that enhance patient care and workplace experiences. We are dedicated to building a supportive and welcoming environment where everyone has the opportunity to thrive and advance professionally. Explore this opportunity and be part of the next chapter in our history. About the Mount Sinai Health System: Mount Sinai Health System is one of the largest academic medical systems in the New York metro area, with more than 48,000 employees working across eight hospitals, more than 400 outpatient practices, more than 300 labs, a school of nursing, and a leading school of medicine and graduate education. Mount Sinai advances health for all people, everywhere, by taking on the most complex health care challenges of our time — discovering and applying new scientific learning and knowledge; developing safer, more effective treatments; educating the next generation of medical leaders and innovators; and supporting local communities by delivering high-quality care to all who need it. Through the integration of its hospitals, labs, and schools, Mount Sinai offers comprehensive health care solutions from birth through geriatrics, leveraging innovative approaches such as artificial intelligence and informatics while keeping patients’ medical and emotional needs at the center of all treatment. The Health System includes more than 9,000 primary and specialty care physicians; 13 joint-venture outpatient surgery centers throughout the five boroughs of New York City, Westchester, Long Island, and Florida; and more than 30 affiliated community health centers. We are consistently ranked by U.S. News & World Report's Best Hospitals, receiving high "Honor Roll" status, and are highly ranked: No. 1 in Geriatrics, top 5 in Cardiology/Heart Surgery, and top 20 in Diabetes/Endocrinology, Gastroenterology/GI Surgery, Neurology/Neurosurgery, Orthopedics, Pulmonology/Lung Surgery, Rehabilitation, and Urology. New York Eye and Ear Infirmary of Mount Sinai is ranked No. 12 in Ophthalmology. U.S. News & World Report’s “Best Children’s Hospitals” ranks Mount Sinai Kravis Children's Hospital among the country’s best in several pediatric specialties. The Icahn School of Medicine at Mount Sinai is ranked No. 11 nationwide in National Institutes of Health funding and in the 99th percentile in research dollars per investigator according to the Association of American Medical Colleges. Newsweek’s “The World’s Best Smart Hospitals” ranks The Mount Sinai Hospital as No. 1 in New York and in the top five globally, and Mount Sinai Morningside in the top 20 globally. Equal Opportunity Employer The Mount Sinai Health System is an equal opportunity employer, complying with all applicable federal civil rights laws. We do not discriminate, exclude, or treat individuals differently based on race, color, national origin, age, religion, disability, sex, sexual orientation, gender, veteran status, or any other characteristic protected by law. We are deeply committed to fostering an environment where all faculty, staff, students, trainees, patients, visitors, and the communities we serve feel respected and supported. Our goal is to create a healthcare and learning institution that actively works to remove barriers, address challenges, and promote fairness in all aspects of our organization. Compensation The Mount Sinai Health System (MSHS) provides salary ranges that comply with the New York City Law on Salary Transparency in Job Advertisements. The salary range for the role is $82.6333 - $82.6333 Hourly. Actual salaries depend on a variety of factors, including experience, education, and operational need. The salary range or contractual rate listed does not include bonuses/incentive, differential pay or other forms of compensation or benefits.