We’re working to create a national model for improving health. Today, we’re focused on bringing our region services that improve every facet of life to drive total health, inside and out. Through professional growth, quality improvement, and interdisciplinary collaboration, we’ve built an innovative culture that allows nurses to grow their skillsets, develop their practice, and leverage their years of experience to build a rewarding, lasting career with impact. Assesses the healthcare, educational and psychosocial needs of the patient and family and involves them in establishing a treatment plan based on realistic goals and interventions. Investigates healthcare options and facilitates communication among the patient, primary care provider and other members of the healthcare team to eliminate barriers and identify interventions for treatment. Applies age-appropriate learning principles to educate patients, family and other health care members on the role and purpose of Care Coordination, its processes, disease, and case management programs and outcomes. Serves as a resource to patients, families and other healthcare team members regarding disease management. Implements clinical interventions based on risk stratification and evidence-based clinical guidelines. Collaborates with primary care providers to enhance evidence-based clinical guideline adherence and promote best practice by initiating and adjusting therapies as directed by the practitioner and providing appropriate follow-up and monitoring as needed. Coordinates laboratory and diagnostic tests for all disease management programs. Collaborates with primary care providers to enhance evidence-based clinical guideline adherence and promote best practice by initiating and adjusting therapies as directed by the practitioner and providing appropriate follow-up and monitoring as needed. Facilitates and coordinates laboratory and diagnostic tests for all disease management programs. Maintains required documentation in EPIC for all disease management activities. Collects and enters data and patient information according to department standards. Attends and participates in professional and nursing continuing education programs and exploits professional development opportunities. Reviews the current literature regarding effective teaching/learning strategies and disease management strategies and incorporates the appropriate techniques into disease management practice. Maintains active involvement in post-discharge Transitions of Care coordination. Assists leadership in the design, implementation and evaluation of care coordination programs to support overall goals and strategic business strategies. Collects and prepares laboratory specimens and completes associated paperwork to expedite laboratory studies with maximum accuracy and efficiency. Inserts, monitors, regulates and discontinues IV's as required by provider and per scope of practice. Administers medications and vaccines, including intradermal and skin testing, under the direction of a provider and per scope of practice.
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Job Type
Full-time
Career Level
Mid Level
Education Level
Associate degree