Care Coordinator RN Heart Center

Children's Health•Dallas, TX

31d•Onsite

About The Position

Utilizing advanced nursing skills and knowledge, the Care Coordinator is responsible and accountable for coordinating care throughout the continuum of care for an assigned patient population. Care Coordination in the hospital and healthcare system is a collaborative practice model. In partnership with the patient, family, and other care givers, the Care Coordinator will work with the multidisciplinary team, Providers, Nurses, Social Workers, financial counselors, and other ancillary staff to actively facilitate those functions associated with moving the patient through the continuum of care. This role will support the continuity of care across the continuum by advocating for the needs of the patient and family and working with identified care team members to promote access to care, facilitate communication and provide effective resource coordination during care transitions to ensure continuity, quality and closure of gaps in care. Identifies and implements initiatives and opportunities to improve processes.

Requirements

At least 4 years Pediatric nursing, Case Management, Care Management, Care Coordination, Utilization Review, or Community-based nursing required
Four-year Bachelor's degree or equivalent experience BSN required
Registered Nurse in the State of Texas Upon Hire required
Effective 7/1/2023, Basic Life Support for Healthcare Providers as required by CP 1.20 Life Support Course Requirements required
Requires in-depth professional knowledge and practical/applied expertise in own discipline and basic knowledge of related disciplines within the broader professional field
Has knowledge of best practices and how own area integrates with others; demonstrates awareness of the industry, including regulatory, evolving customer demands, and the factors that differentiate the organization in the market
Acts as a resource for colleagues with less experience; may lead projects with manageable risks and resource requirements
Solves complex problems and takes a new perspective on existing solutions; exercises judgment based on the analysis of multiple sources of information
Impacts a range of customer, operational, project or service activities within own team and other related teams; works within broad guidelines and policies
Works independently, receives minimal guidance
Explains difficult or sensitive information; works to build consensus
Maintain effectiveness when experiencing major changes in work responsibilities or environment; adjust effectively to work within new work structures, processes, requirements, or cultures.
Use appropriate interpersonal styles to establish effective relationships with customers and internal partners; interact with others in a way that promotes openness and trust and gives them confidence in one's intentions.
Meet patient and patient family needs; take responsibility for a patient's safety, satisfaction, and clinical outcomes; use appropriate interpersonal techniques to resolve difficult patient situations and regain patient confidence.
Ensure that the customer perspective is a driving force behind business decisions and activities; craft and implement service practices that meet customers' and own organization's needs.
Develop and use collaborative relationships to facilitate the accomplishment of work goals.
Identify and understand issues, problems, and opportunities; compare data from different sources to draw conclusions; use effective approaches for choosing a course of action or developing appropriate solutions; take action that is consistent with available facts, constraints, and probable consequences.
Take prompt action to accomplish objectives; take action to achieve goals beyond what is required; be proactive.
Deal effectively with others in an antagonistic situation; use appropriate interpersonal styles and methods to reduce tension or conflict between two or more people.
Effectively manage one's time and resources to ensure that work is completed efficiently.
Accomplish tasks by considering all areas involved, no matter how small; showing concern for all aspects of the job; accurately checking processes and tasks; being watchful over a period of time.
Set high standards of performance for self and others; assume responsibility and accountability for successfully completing assignments or tasks; self impose standards of excellence rather than having standards imposed.
Assimilate and apply new job-related information in a timely manner.
Clearly convey information and ideas through a variety of media to individuals or groups in a manner that engages the audience and helps them understand and retain the message.

Nice To Haves

Accredited Case Manager (ACM) or Certified Case Manager (CCM) or Care Coordination and Transition Management (CCTM) Upon Hire preferred

Responsibilities

Responsible and accountable for prescribing, delegating and coordinating patient care. Uses clinical judgment based on nursing skills acquired through formal and informal experiential knowledge and evidence based guidelines to globally assess the patient's situation and through critical thinking and clinical decision making, develop an appropriate plan of care for the patient, with the aim of promoting best outcomes.
Accountable that patient care meets standards of safety, effectiveness, patient rights and guest relations.
Oversees care delivered by patient care team; coordinates plan of care.
Provides education and facilitates learning for patients, families, and patient care team in a way that demonstrates a sensitivity to recognize, appreciate, and incorporate differences related to diversity.
Collaborates with physicians, families and other healthcare professionals to assist in developing and implementing an appropriate plan of care in a way that promotes/encourages each person's contributions towards achieving the best patient outcomes.
Advocates for the patient, represents the concerns of the patient/family and identifies and assists in resolving ethical and clinical concerns.
Will deliver care with a team-orientation, an emphasis on good customer relations, sound clinical judgment and appropriate decision-making abilities that take into consideration evidence based practice.
Continuously inquires about the condition of the patient through the ongoing process of questioning and evaluating the situation and implements treatment changes, if necessary, through collaboration with the health care team, inclusive of the patient and family.
Maintains a body of knowledge and tools that allow the nurse to manage whatever environmental and system resources exist for the patient/family, within or across healthcare and non-healthcare systems.
Completes and analyzes comprehensive assessment with patient intake
Treatment plan coordination and management to include payors, supplies and equipment, medications, in-house services, other healthcare facilities and community resources/entities
Collaborates with the health care team on the plan of care, referrals and ongoing needs of the patients
Ensures consults, testing and procedures are sequenced in a manner that is appropriate to the patient's clinical condition and supports timely and efficient care delivery. Intervenes, resolves or escalates where barriers to service exist
Utilize disease-specific clinical pathways to ensure effective clinical / disease management
Assess the educational needs of patients, families, and caregivers taking into consideration barriers to care (e.g., literacy, language, cultural influences, comorbidities)
Ensure that education regarding the clinical / disease process has been provided by the health care team
Coach patients/families toward lifestyle changes and successful self-management of their chronic disease
Demonstrate customer-focused interpersonal skills, utilizing problem-solving processes and critical thinking
Facilitates communication and coordination of the plan of care with the Providers and the health care team
Involvement in the development of strategies and plans to maximize the most appropriate use of services in the assigned areas
After considering the relevant, evidence-based clinical information, support and advise patients, families and the organization in the care options that are most cost-effective
Navigate payor benefits and assist patients and families in understanding insurance plan benefits and financial impact with transition management and discharge planning
Understand impact on the organization and utilize knowledge of Diagnosis Related Groupings and estimated length of stay as guides when developing discharge plans
Understand the negative impact of readmissions on the patient and the health care system, and engage in review of root cause and implementing strategies to prevent readmission
Identifies and addresses actual and potential barriers in service or treatment and works with the appropriate resources across the continuum of care
Evaluates with the team, the patient's response to pharmacological and therapeutic treatment regimens
Works with multidisciplinary staff to ensure patient / family has received appropriate information and education prior to transition to the next level of care
Identify and solve problems related to discharge needs; implement a plan of care and coordinate a safe and timely discharge
Ensure / maintain plan consensus from patient / family, healthcare team and payor
Advocate, mediate and negotiate to formulate a cohesive plan for maintaining or enhancing patient's health status and moving the patient safely to the next level of care
Communicate and resolve conflicts with Providers, health care team members, community agencies, clients and families with diverse opinions, values, and religious/cultural ideals
Build therapeutic and trusting relationships with patients, families and caregivers through effective communication and listening skills
Continually communicate with patients and families, Providers, multidisciplinary team members and payors to facilitate coordination of clinical activities and to enhance the effect of a seamless transition from one level of care to another across the continuum
Works to improve quality through reduction in treatment delays, use of clinical pathways and monitoring of quality indicators
Provide ongoing consultation and training to medical staff and other healthcare professionals on discharge and home care issues; participate in process improvement activities; identify barriers in service delivery systems and develop a process for improvement
Increase quality, efficiency and patient satisfaction while managing cost of care for targeted population
Collects, completes and submits statistical data in a timely manner
Remain current in EMTALA and regulatory requirements
Stay abreast of payor guidelines and standards
Stay abreast of community resources available to facilitate safe patient transitions of care
Remain current on clinical advancements related to primary patient population
Proactively seek to understand areas/roles outside of immediate area/role within the department
Community involvement and advocacy: participates in health fairs, appropriate professional organizations and educational speaking