RN Care Coordinator - PACE OF OZARKS

Description

Organization Overview, Mission, Vision, and Values

Our mission is to improve the health of people in the communities we serve through compassionate, high-quality care, prevention, and wellness education. Washington Regional Medical System is a community-owned, locally governed, non-profit health care system located in Northwest Arkansas in the heart of Fayetteville, which is consistently ranked among the Best Places to live in the country. Our 425-bed medical center has been named the #1 hospital in Arkansas for four consecutive years by U.S. News & World Report. We employ 3,400+ team members and serve the region with over 45 clinic locations, the area’s only Level II trauma center, and five Centers of Excellence - the Washington Regional J.B. Hunt Transport Services Neuroscience Institute; Washington Regional Walker Heart Institute; Washington Regional Women and Infants Center; Washington Regional Total Joint Center; and Washington Regional Pat Walker Center for Seniors.

 Job Summary:

Under the supervision of the Director and under the direction of primary care is responsible for nursing assessments of participants and their goals and works within the Interdisciplinary Team to develop the Plan of Care. Coordinate, provide and monitors ongoing nursing care / treatment as required. As a member of the Interdisciplinary Team the RN works with participants to increase independence and community integration through a model of self-determination which maximizes physical, mental and functional health. Collaborates with Quality Coordinator and Medical Director regarding quality improvement, initiatives and providing supporting data collection for analysis.

Essential functions and Responsibilities:

• Conducts initial nursing history and physical exam; additional assessments as required to include Braden Skin and functional assessments.
• Develops nursing plan of care for participants, provides nursing care and services to participants per plan of care; performs in-person and on-going participant assessments and updates nursing care plans as indicated / required.
• Functions as a member of the interdisciplinary team. Maintains regular attendance at, and participation in, interdisciplinary team meetings; collaborates on care planning and service allocation decisions.
• Keeps team informed of changes in health or functional status of participants and home care needs.
• Monitors participant medications and treatments prescribed by the medical providers. Provides medication and treatment education to participants and caregivers as necessary.
• Triages participants by phone and in person as need arises.
• Appropriate and timely documentation in health record per policy.
• Assists participants in maintaining optimal health through education and counseling with participants, caregivers and family facing chronic conditions and end of life issues.
• Provides direction for Certified Nurse Aides regarding personal care and treatment plans for participants in the ADHC.
• Assists in coordinating services provided by specialists and contracted services to ensure smooth transition of care as needed.
• Coordinates with contracted nursing homes and other contracted providers for admissions and discharge planning to ensure smooth transitions of care.
• Monitoring and providing data for infection control, quality data for submission for reporting as well as providing overall standards of care.
• Required on call rotation to facilitate 24/7 health care delivery.
• Supports Quality Improvement efforts within committee.
• Protects privacy and maintains confidentiality of employee, participant and sensitive agency information.
• Supports agency’s mission and values.

Qualifications and Requirements:

Education: Unencumbered Licensure for Registered Nurse in the State of Arkansas. CPR certification required.

Experience: A minimum of one-year experience working with frail and elderly population is required. One-year experience working within a managed care or in a community based or long-term care setting. Working knowledge of physical, mental and social needs of the frail elderly.

Skills and Knowledge:

• Ability to plan and coordinate meaningful staff training.
• Working knowledge of physical, mental and social needs of the frail elderly.
• Effective written and oral communication skills.
• Effective problem-solving skills.
• Productive as both an independent and team contributor.
• Well organized; ability to effectively prioritize, plan and execute responsibilities.
• Ability to use or be trained in computer skills for the workplace.
• Demonstrates necessary skills and knowledge as outlined in attached position-specific Competency Assessment Profile.

Qualifications