AdventHealth RN Care Coordinator Bridge Care in Shawnee, Kansas

Description

RN Care Coordinator Bridge Care AdventHealth Shawnee Mission

Location Address: 9100 W. 74 th Street, Mission, KS 66204

Top Reasons To Work At AdventHealth Shawnee Mission

· Providing faith-based, whole person care to Kansas City since 1962

· Excellent health benefits, an onsite child care center and fitness facility

· Tuition reimbursement to support continuing education

· Employee Referral Program

· Largest health care provider in Johnson County with three campuses

Work Hours/Shift:

Full-time / Days

Flexible to work 36-40hrs/week; 8-10hrs/shift

No weekends, evenings or holidays

You Will Be Responsible For:

  • Demonstrate and convey a favorable image of the Medical Center.

  • Attend in service programs of continuing education and review current literature as a means to evaluate and enhance current treatment practices.

  • Adjust and enhance clinical expertise to meet changing healthcare needs.

  • Admit mistakes openly and seeks ways to correct the problem. Create a safe environment for honest and open communication.

  • Seek appropriate consultation.

  • Incorporate and maintain a professional practice pattern that includes assessment of psychosocial functioning, adaptation to illness, post hospital planning, psychosocial assessment/evaluation and facilitates referrals to community agencies, financial planning and provision of information and resource knowledge.

  • Apply appropriate criteria to identify patients who are at high risk for readmission or for high emergency room utilization.

  • Display a high level of flexibility, adaptability and organization skills in response to the caseload and to effectively prioritize cases.

  • Conduct patient and family education, utilizing Teach Back method.

  • Identify and advocate of client needs lacking in community systems.

  • Function as a treatment team member, interpreting social, psychological, emotional and family system problems and strengths to other members of the treatment team.

  • Incorporates patient, physician, customer needs and concerns into decision-making and organizational action.

  • Form collaborative working relationships with key community agencies. Partner with other community resources to leverage range of service provided to the client and client system.

  • Prioritize clinical problems, formulate treatment goals and construct treatment plan, revising as needed, based on continuous evaluation and assessment of progress.

  • Provide an in-depth comprehensive psychosocial assessment of the patient and their support system as needed. Identify and intervene regarding specific age and developmental issues for middle age and older adults.

  • Acquires working knowledge of motivational interviewing and working with resistant clients.

  • Document direct service in patient’s medical record after each significant contact and at closure of case, according to Shawnee Mission Health and regulatory standards.

  • Evaluate practice upon completion of case intervention, determining whether intervention was adherent to contract and whether client achieved expected outcome.

  • Demonstrate ability to quickly appraise crisis situation and select appropriate intervention(s).

  • Mediate highly complex situations and develop treatment plans with minimal supervision.

  • Participate in community outreach and marketing through: public speaking, in-services, workshops, conferences and community presentations.

  • Participate in various hospital and department committees, including Performance Improvement (PI) activities.

  • Function as a field practicum instructor for University students as appropriate.

  • Educate interdisciplinary team how to make appropriate referrals regarding patients needing community care coordination services.

  • Produce expected quantity of services as determined by worker time/caseload allocation plans.

  • Accept special projects as assigned.

  • Provide and record ongoing data on caseload for purposes of program evaluation.

  • Identify and visit patient in the Emergency Department. Make follow up visits to the patient at location of post discharge transfer.

  • Identify gaps in service that prevent the patient from achieving increased stability in daily living.

  • Participate in ongoing program evaluation with Physician Champions.

Qualifications

What You Will Need:

  • Bachelor's Degree in Nursing

  • Kansas Registered Nurse License

  • 1-2 years of experience

Job Summary:

The RN Care Coordinator Bridge Care will identify and work with patients who present to the Emergency Department. The Coordinators will initially meet the patient at the time of an ED visit and will provide community case management services. This program is based on a holistic bio psychosocial model and will assess various domains of health as a means to improving the patient’s health status and psychosocial functioning. Strategies for patient management include, but are not limited to, Teach Back method of discharge instruction, assistance in setting up PCP appointment within 72 hours, home visits to assist with medication reconciliation and other self -management techniques, ongoing telephone follow up, assistance with psychosocial issues and gaps in service and support of caregivers as appropriate. Transition management will also be provided to patients who discharge to a destination other than home and the strategies will be appropriate to that level of care.

The RN Care Coordinator Bridge Care will work as part of an interdisciplinary Community Care Program Team. The core members of the team will be the Transitional Coaches, the Program Director, the ED Physician champion(s) and other disciplines as indicated by the needs of the patient. These can include nursing, pharmacy, rehabilitation, nutrition services and other ancillary services.

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.

We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.