Care Coordinator

• Three Rivers, MI
• TRH Population Health/Care Coordinator
• Three Rivers Health
• Full-time - Day - Mon-Friday 8:00-4:00; 9:00-5:00
• Req #: 214128
Posted: November 27, 2024-->

Summary

Reports to Patient Care Service Manager. Provides coordination to designated patient population who are admitted to the hospital or its emergency department, provides coordination of care and clinical information between outpatient physicians and hospital care team personnel including its emergency department physicians, hospitalists, consulting physicians, discharge planners to insure efficient, timely care and seamless transition of patient care from one physical setting to another or from one care provider to another.

MISSION, VALUES and SERVICE GOALS

• MISSION: We deliver outstanding care, inspire health, and connect with heart.
• VALUES: Trust. Respect. Integrity. Compassion.
• SERVICE GOALS: Personally connect. Keep everyone informed. Be on their team.

Coordinates patient care within established caseloads by:

• Greets patient/family as immediately as practical, patients of specific designated providers who present to hospital emergency department or inpatient admission.
• Engages with hospital care team, emergency department physicians, hospitalists, nurses, discharge planners/social workers to offer assistance, transmit patient record information relevant to circumstances, receive updated clinical and care plan information.
• Communicate with patient's primary care and specialist physicians to keep them apprised of patient status and care plans.
• Provides assistance to hospital care team through arrangements for timely specialty consultations as they may require.
• Collaborates with hospital discharge personnel. Apprises patient's primary care physician of planned discharge arrangements.
• Coordinates post discharge appointments.
• Coordinates transitional care services to include patient's discharge medication reconciliation.
• Engages with patient's family to assist hospital care team with family communication and post discharge care planning and instruction.
• Communication of all patient care is thorough, objective, concise, and follows appropriate legal guidelines.

Participates in continuous quality improvement by:

• Making recommendations as appropriate to improve overall quality of patient care.
• Preparing summaries and reports for review by the Director as requested.

Performs other functions to maintain personal competence and contribute to the overall effectiveness of the department by:

• Completing other job-related assignments and projects as directed.

ORGANIZATIONAL RESPONSIBILITIES

Associate complies with the following organizational requirements:

• Attends and participates in department meetings and is accountable for all information shared.
• Completes mandatory education, annual competencies and department specific education within established timeframes.
• Completes annual employee health requirements within established timeframes.
• Maintains license/certification, registration in good standing throughout fiscal year.
• Direct patient care providers are required to maintain current BCLS (CPR ), and other certifications as required by position/department.
• Consistently utilizes appropriate universal precautions, protective equipment, and ergonomic techniques to protect patient and self.
• Adheres to regulatory agency requirements, survey process and compliance.
• Complies with established organization and department policies.
• Available to work overtime in addition to working additional or other shifts and schedules when required.

Commitment to Beacon's six-point Operating System, referred to as The Beacon Way:

• Leverage innovation everywhere.
• Cultivate human talent.
• Embrace performance improvement.
• Build greatness through accountability.
• Use information to improve and advance.
• Communicate clearly and continuously.

Education and Experience

• The level of knowledge, skills and abilities indicated below are normally acquired through the successful completion of a Baccalaureate Degree in Nursing (current RN license in State of Michigan). M inimum of three years related clinical experience.

Knowledge & Skills

• Ability to work with a diverse patient and physician population.
• Demonstrates effective analytical and problem-solving skills.
• Demonstrates clear, effective communication skills, including verbal, written, and listening skills.
• Demonstrates well developed interpersonal skills necessary to promote and maintain cooperative, courteous, and sincere relationships with patients, family members, physicians, staff, and the public.
• Requires ability to independently prioritize and organize work activities and work effectively under pressure and in a fast-paced environment.
• Requires ability to identify and utilize appropriate resources.
• Has knowledge of general insurance guidelines and requirements to facilitate direct patient care and avoid unnecessary or duplicative care and expense.
• Exhibits computer systems knowledge and proficiency as necessary to perform job functions.

Working Conditions

• Works in various environments including patient care areas with frequent changes in job demands.

Physical Demands

• Requires the physical ability and stamina to perform the essential functions of the position.
• Travel required
• Clear communication and speaking voice for telephone speaking required.