Clinical Nurse Coordinator- FT

HOPE ENTERPRISES•Williamsport, PA

11d•Hybrid

About The Position

The Clinical Nurse Coordinator provides nursing leadership, assessment, care coordination, and staff education to improve the health and well-being of individuals supported by Hope. The role leads early identification of health risks, safe hospital transitions, staff competency development, and evaluation of health outcomes. The nurse partners with individuals, families or authorized representatives, treating providers, program leaders, support coordinators, and Quality Management while respecting individual choice, privacy, and nursing scope of practice. The position primarily supports Residential services, with support to Life Sharing, Supportive Living, Choice, and other programs as assigned by the Chief Operating Officer according to clinical need, program requirements, and available capacity. The role requires regular travel among assigned sites and a hybrid office environment with remote and on-site work as required. The normal schedule is established with the Chief Operating Officer and may be adjusted for site visits, training, and hospital transitions. Occasional after-hours telephone consultation or in-person nursing response may be requested when clinically appropriate; a stipend is provided for requested after-hours residential nursing care, subject to availability. The nurse provides professional nursing direction within assigned responsibilities and makes clinical recommendations based on assessment and available information. The nurse identifies required clinical training and verifies applicable competency before recommending staff readiness for an intervention. If an intervention cannot be performed safely with available orders, competency, or resources, the nurse directs immediate clinical escalation and promptly notifies the responsible program leader and Chief Operating Officer. The nurse escalates unresolved health risks, unmet clinical recommendations, and barriers to safe transitions to the Chief Operating Officer. Program leaders remain accountable for staffing, scheduling, and operational implementation; treating providers retain prescribing and medical treatment responsibilities; and Quality Management retains its assigned investigation and incident-management responsibilities. This is a 40-hour-per-week, exempt position with no positions supervised. A valid driver’s license, personal vehicle for work-related travel, and insurability under Hope’s insurance carrier are required. Essential functions may be performed with or without reasonable accommodation.

Requirements

A four-year degree is listed as the education level.
Experience supporting individuals with intellectual and developmental disabilities, in community health, long-term care, or with individuals with complex health needs.
Experience with clinical program development, staff education, quality improvement, HRST, and Pennsylvania ODP service requirements.
A valid driver’s license, a personal vehicle for work-related travel, and insurability under Hope’s insurance carrier.
Ability to read, write, comprehend information, perform moderately difficult math, and demonstrate advanced communication skills.
Ability to maintain required competencies and perform duties consistent with licensure and training.
Ability to travel regularly among assigned sites and perform the position’s essential functions, with or without reasonable accommodation.

Nice To Haves

Certified Diabetes Care and Education Specialist (CDCES) credential or relevant diabetes education experience.

Responsibilities

Assess changes in health status, identify nursing needs, and communicate findings and recommendations to treating providers and support teams.
Perform authorized nursing interventions within current competency, applicable orders, agency policy, and available resources.
Document assessments, interventions, communications, and follow-up in the designated clinical record; arrange further evaluation or emergency escalation when indicated.
Complete and maintain applicable Health Risk Screening Tool (HRST) rater and clinical reviewer training and qualifications; coordinate HRST workflow, conduct timely nursing reviews, document reviews and sign-offs, and track follow-up on identified risks.
Work with assigned raters and program leaders to address overdue HRST reviews and unresolved concerns.
Lead Hospital Transition Planning Committee meetings and provide clinical guidance to support safe transitions from hospital to home.
Assist residential teams in identifying changes in medical needs, reviewing discharge instructions, determining necessary clinical supports, and providing or arranging staff education related to new medical needs or interventions.
Provide nursing consultation on clinical concerns and recommend follow-up or escalation when indicated.
Participate in the referral committee; assess anticipated clinical needs, medication complexity, equipment, staff competency, and available supports; provide documented recommendations before admission or service expansion.
Serve as a clinical resource to the Training Department on diabetes care, insulin administration, medication safety, and individual-specific medical needs.
Pursue qualifications to provide required annual insulin administration training, as agreed with the Chief Operating Officer, and deliver training once instructor qualifications and program approvals are met.
Collaborate with medication administration trainers, pharmacy, and program leaders to address medication concerns and reduce errors.
Use HRST findings and other clinical data to identify health changes and coordinate individualized follow-up with the person and care team.
Lead prevention and education addressing aspiration, bowel complications, dehydration, seizures, infection and sepsis, falls, and other significant risks.
Develop and evaluate accessible, person-centered wellness education and activities; maintain evidence of participation, adaptations, outcomes, and improvement in support of applicable ODP Performance-Based Contracting health and wellness standards.
Develop practical staff education on recognizing changes in condition, individual-specific interventions, medical devices, infection prevention, and emergency response; evaluate and document competency where applicable.
Coordinate training needs with program leaders and Human Resources as warranted.
Partner with Quality Management to review clinical aspects of health incidents, medication errors, falls, hospital use, and recurring concerns; recommend corrective actions, identify responsible parties with program leadership, and evaluate effectiveness.
Maintain useful clinical dashboards and provide quarterly reports to the Chief Operating Officer, with prompt reporting of urgent risks.
Participate in the policy subcommittee; develop and recommend clinical policies, procedures, and escalation guidance for approval.
Support regulatory preparation and implementation of clinical requirements; consult with program leaders and coordinate with external nursing, medical, pharmacy, hospice, and other providers to maintain clear responsibilities and continuity of care.
Travel to assigned sites and perform nursing assessments, authorized interventions, education, recordkeeping, communication, and safety or crisis intervention skills as needed.
Follow confidentiality, professional boundaries, person-centered practices, individual support plans, safe handling procedures, and agency safety protocols; maintain required competencies and perform duties consistent with licensure and training.
Respond to requested after-hours residential nursing care when clinically appropriate and available.