RN Care Facilitator, Ed BWH

Mass General Brigham•Boston, MA

5d•$42 - $106•Onsite

About The Position

The Emergency Department Care Facilitator (EDCF) proactively coordinates patient care in a fast-paced emergency department setting utilizing clinical assessment skills to identify patient needs, coordinate care, manage utilization, and support safe transitions of care while supporting patient flow and throughput from the emergency department. The EDCF serves as a key partner to ED physicians, nurses, the interdisciplinary team, and community partners and resources to support timely, appropriate care decisions.

Requirements

Graduate of an approved school of nursing with current registration in Massachusetts.
For newly licensed nurses a Bachelor of Science Degree in Nursing is required.
Knowledge and skills to differentiate levels of care required.
Five years of previous acute care experience required, strongly preferred in emergency nursing.
Two or more years experience in hospital utilization review preferred.
Five years experience in an acute setting with discharge planning and knowledge of community resources required.
Must be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patients served on their assigned unit.
Previous experience in an acute hospital setting
strong clinical assessment skills
excellent interpersonal skills including ability to work collaboratively and cooperatively within a team
strong organizational skills and ability to set priorities
ability to compile data from concurrent and retrospective medical record review to determine discharge plans and create plans to reduce readmissions.

Nice To Haves

bilingual preferred

Responsibilities

Collaborates with ED providers and care teams to assess patient needs upon presentation.
Facilitates patient transfer of care and communicates care plans to referral sources, receiving providers, and support resources.
Participates in the ongoing evaluation of practice patterns and systems, and supports efforts to improve quality, cost of care, and satisfaction outcomes.
Mobilizes resources to maximize efficiency of care delivery and quality of care in accordance with regulations and hospital policy and procedures.
Maintains a flexible work schedule to match availability to patient demand.
Coordinates and ensures implementation of the plan of care, utilizing case management principles.
Participates in processes to facilitate transition of care and identifies opportunities for improved utilization of care delivery resources to meet patient needs.
Upon presentation to the ED, collaborates with the interdisciplinary care team to assess care needs and determine needs for discharge support and/or transition of care.
Presents alternative care delivery sites to ED providers, and the patient and family when appropriate.
Reviews patients past medical history and current treatment plan with ED providers to ensure optimal coordination and resource utilization.
Participates in ED patient rounds to identify and contribute to case finding opportunities for improved coordination of care and high-risk patient identification.
Communicates high risk patient’s needs and follow-up plans of care to community-based and/or hospital-based care coordinators.
Forms and maintains relationships with community-based providers to enhance transition of patient care between the ED and the community.
Incorporates knowledge of emergency medicine, utilization management, and community providers into patients' plan of care, and informs ED providers of implications and opportunities.
Assesses needs for continuing care in conjunction with patient’s family and/or caregivers.
Initiates contact with patient transfer and access department and/or other acute care hospitals, post-ED care facilities, and home health agencies to ensure prompt transitions of care.
Facilitates all discharge plans requiring post-ED care. Works in partnership with the ED social workers and staff nurses to facilitate transition of care.
Participates in decision to admit patients to determine appropriateness of admission and prevent unnecessary admissions.
Identifies patients who have or are likely to have unmet insurance needs and communicates with and/or makes referral to the ED social worker and/or appropriate departments and inpatient care coordination staff.
Investigates and recommends to ED providers alternative care delivery sites based on level of care and insurance benefits. Contributes to utilization and improvement efforts.