This job functions as the liaison and communicator with the patient, caregivers, healthcare providers, and multi-disciplinary team members, as well as post-acute care and third party payers. Discusses alternative care options with patient/caregivers as well as the multi-disciplinary team and assists with discharge planning needs. Facilitates movement along the healthcare continuum to ensure quality, cost effective outcomes are achieved in collaboration with the multi-disciplinary team.
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable qualified individuals with disabilities to perform the essential duties.
This job description is a summary of the primary duties and responsibilities of the job and position. It is not intended to be a comprehensive or all-inclusive listing of duties and responsibilities. Contents are subject to change at the company's discretion.
Education
Required - Registered nurse diploma.
Work Experience
Preferred - Associate or bachelor's degree in nursing.
Required - 2 Years Of Nursing Experience.
Certifications
Required - Current registered nurse (RN) license in state of practice.
Basic Life Support (BLS) from the American Heart Association.
Preferred - Certification In Clinical Specialty Area.
Knowledge Skills and Abilities (KSAs)
- Proficiency in using computers, software, and web-based applications.
- Effective verbal and written communication skills and ability to present information clearly and professionally to varying levels of individuals throughout the patient care process.
- Excellent conflict resolution skills.
- Ability to work a flexible work schedule (e.g. 24/7, weekend, holiday, on call availability) and travel throughout and between facilities.
Job Duties
- Provides continuity of care by ensuring smooth transitions between care settings.
- Develops relationships with patients and their multidisciplinary team to facilitate and/or navigate through subsequent treatment and follow-up to reflect continuity of care.
- Manages high risk, complex patient care with the goal of minimizing readmission.
- Works closely with physicians to coordinate patient’s care plan communication; works with multidisciplinary team to maintain and implement up-to-date coordinated patient centered care plan; communicates with all members of the healthcare team as patient advocate.
- Prepares, executes, and reinforces post-discharge care plan.
- Identifies barriers to care in an effort to elicit changes in processes for patients navigating the continuum of care.
- Collaborates with leadership to review processes with the goal of improving the clinical experience for referred patients and the referring physician.
- Adapts behavior to the specific patient population, including but not limited to respect for privacy, method of introduction to the patient, adapting explanation of services or procedures to be performed, requesting permissions and communication style.
- Performs other related duties as required.
The above statements describe the general nature and level of work only. They are not an exhaustive list of all required responsibilities, duties, and skills. Other duties may be added, or this description amended at any time.
Remains knowledgeable on current federal, state and local laws, accreditation standards or regulatory agency requirements that apply to the assigned area of responsibility and ensures compliance with all such laws, regulations and standards.
This employer maintains and complies with its Compliance & Privacy Program and Standards of Conduct, including the immediate reporting of any known or suspected unethical or questionable behaviors or conduct; patient/employee safety, patient privacy, and/or other compliance-related concerns.
The employer is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran status, or disability status.
Physical and Environmental Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Medium Work - Exerting 20 to 50 pounds of force occasionally, and/or 10 to 25 pounds of force frequently, and/or greater than negligible up to 10 pounds of force constantly to move objects. (Constantly: activity or condition exists 2/3 or more of the time) to move objects. Physical demand requirements are in excess of those for Sedentary Work. Even though the weight lifted may be only a negligible amount, a job should be rated Light Work: (1) when it requires walking or standing to a significant degree; or (2) when it requires sitting most of the time but entails pushing and/or pulling of arm or leg controls; and/or (3) when the job requires working at a production rate pace entailing the constant pushing and/or pulling of materials even though the weight of those materials is negligible. NOTE: The constant stress and strain of maintaining a production rate pace, especially in an industrial setting, can be and is physically demanding of a worker even though the amount of force exerted is negligible.
Duties performed routinely require exposure to blood, body fluid and tissue.
The incumbent works in a patient care area; works in an area where patients enter; works directly with patients; and/or works with specimens that could contain diseases. There may be an occupational risk for exposure to all communicable diseases.
Because the incumbent works within a healthcare setting, there may be occupational risk for exposure to hazardous medications or hazardous waste within the environment through receipt, transport, storage, preparation, dispensing, administration, cleaning and/or disposal of contaminated waste. The risk level of exposure may increase depending on the essential job duties of the role.
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Individuals who reside in and will work from the following areas are not eligible for remote work position: Colorado, California, Hawaii, Maryland, New York, Washington, and Washington D.C.
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