RN Care Coordinator
Company: Children's Hospital (Omaha)
Posted on: June 25, 2019
Just like the children we serve, Children's is growing quickly and
hiring a RN Care Coordinator for the Cardiology department. Serve
the adult congenital heart disease patient population at both
Children's and Nebraska Medicine. Act in an expanded health care
role to collaborate with the Adult Congenital Heart Disease
practice team, specialists, members of community health care teams,
and patients/families to ensure the delivery of quality,
cost-effective health care services. Assess, plan, implement,
coordinate, monitor and evaluate all options and services to
optimize patient health. Integrate evidence-based clinical
guidelines, preventive guidelines, and protocols in the development
of individualized care plans that are patient-centered, promoting
quality and efficiency. In partnership with the primary care or
specialty clinic team, lead care coordination within the team
through process improvement, workflow redesign, providing
assistance with training, and delegating to other members of the
% of Time 10%
Teaches the patient/family about all aspects of congenital heart
disease such as anatomy/physiology, medications, blood work,
activities, and follow-up.
- Obtains cardiac catheterization permits when necessary after
teaching the patient/family about the procedure and related
- Monitors outpatient lab work and reports findings to
cardiologist as needed.
- Authorizes prescription refills under cardiologist
- Provides outpatient cardiology clinic coverage as needed.
Develops individualized patient/family education plans. Instructs
and counsels patient/family regarding acute/chronic illnesses, the
use of prescribed treatments and medications, care coordination,
and psychosocial needs.
- Responsible for developing a comprehensive, individualized plan
of care and targeted interventions.
- Implements clinical interventions and protocols based on risk
stratification and evidence-based clinical guidelines.
- Continually monitors patient/family response to plan of care
and revises the care plan as indicated.
Collaborates with Providers, patients, families, and members of
health care teams across a continuum of care settings and the
- Fosters a team approach and includes patient/family as active
members of the team.
- Takes the lead in ensuring the continuity of care which extends
beyond the clinic boundaries.
- Serves as liaison to acute care hospitals, specialists,
post-acute care services and community agencies.
- Provides follow-up with patient/family when patient transitions
from one setting to another.
- Completes timely post-hospital follow-up activities including
medication reconciliation, Provider or Specialist follow-up
appointments, review of discharge instructions, condition specific
education, coordination of care, and assists in problem solving
Maintains comprehensive medical record documentation on the
appropriate information systems and databases using required
documentation and billing guidelines.
- Utilize EHR activities to manage preventative care for
- Assist in the development of adequate workflows to ensure
patient care needs are met.
- Proactively reach out to patients most in need of care by
utilizing EHR reporting tools.
- Manage the care of high risk patients using EHR patient
outreach tools, which may include but not limited to: managing
health maintenance, creating and tracking patient goals and
completing appropriate patient assessments via telephone.
Works with clinic and leadership to continuously evaluate process,
identify problems, and propose/develop process improvement
strategies to enhance care management and the Patient Centered
Medical Home delivery of care model. 5%
Participates in teaching/coaching clinic staff in the management of
patient conditions. Assesses staff educational needs and develops
educational programs. Promotes opportunities and activities.
Regular attendance at work is an essential function of the job.
Perform physical requirements as described in the Physical
Requirements section SECONDARY FUNCTIONS/COMPETENCIES 5%
- Performs other duties as assigned
KNOWLEDGE, SKILLS AND ABILITIES:
- Demonstrated written and verbal communication skills
- Ability to apply the nursing process to acute patient care to
- Current knowledge of the healthcare environment, including
community resources and financial systems
- Working knowledge of basic computer programs such as word,
excel. Knowledge of smart phone use
EDUCATION AND EXPERIENCE:
- Bachelor's degree from an accredited college or university in
- Experience with adult or pediatric cardiovascular patients
- Minimum five years in nursing required, preferably in a
- Current and valid Nebraska RN license/RN Compact license
- Certification in Basic Life Support required to work
- Current and valid Case Management certification required or
obtained within 3 years
Keywords: Children's Hospital (Omaha), Sioux City , RN Care Coordinator, Healthcare , Omaha, Iowa
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