Chronic Care Coordinator Strawberry Wilderness Community Clinic | Part Time

Blue Mountain Hospital District • John Day, OR

275d

About The Position

The Chronic Care Coordinator will work in a collaborative role with the Medical Director, Clinic RN, Medical Assistants, and Clinic Director to provide personalized care to individuals managing chronic illness. They will be collaborating closely with patients, families, and healthcare professionals to implement tailored care plans and optimize health outcomes to enhance quality of life for those facing long-term health challenges.

Requirements

• Associate Degree in Nursing.
• Basic Life Support (BLS) certified by American Heart Association (AHA). MUST obtain within 60 days of hire.
• RN License, in good standing with State of Oregon.
• Valid Permit or Driver's License.

Nice To Haves

• BSN.
• Understanding of CMS regulations regarding rural health clinics.
• Working experience in critical access hospital setting.

Responsibilities

• Promotes the mission, vision, and values of the BMHD.
• Collaborates with providers and clinic staff on quality improvement initiatives.
• Diabetic Management and Instruction.
• Triage assessments with communications between hospital/clinic.
• Conduct comprehensive assessments of patients with chronic illnesses, including medical history, current symptoms, and psychosocial factors.
• Develop individualized care plans in collaboration with patients, families, and healthcare providers, focusing on disease management, symptom control, and lifestyle modifications.
• Monitor and evaluate patients' health status, response to treatment, and adherence to care plans on an ongoing basis.
• Provide education and support to patients and families regarding their condition, treatment options, medications, and self-management strategies.
• Coordinate care and facilitate communication between healthcare providers, specialists, and community resources to ensure continuity of care.
• Advocate for patient's needs and rights, addressing barriers to access healthcare services and promoting patient-centered care.
• Utilize evidence-based practices and clinical guidelines to deliver high-quality, cost-effective care and achieve optimal patient outcomes.
• Performs Annual Medicare Wellness Visits in conjunction with providers.
• Document patient assessments, interventions, and outcomes accurately and timely in electronic health records (EHR) or other designated systems.
• Participate in quality improvement initiatives, research projects, and professional development activities to enhance clinical practice and promote innovation in chronic care management.

What This Job Offers

• Job Type: Part-time
• Career Level: Entry Level
• Industry: Nursing and Residential Care Facilities
• Education Level: Associate degree