Nurse (Care Coordinator)

Found in: beBee jobs US - 1 week ago

Crow Agency, Montana, United States Department Of Health And Human Services Full time
Summary

Join our team of health care professionals committed to improving the quality of health care delivery against the stunning backdrop of the Rocky Mountains' snowcapped peaks and sweeping vistas of the Great Plains in the Billings, Montana area These Nurse (Care Coordinator) positions are located at the Crow/Northern Cheyenne Hospital in Crow Agency, Lodge Grass Health Clinic and Pryor Health Station and are responsible for ensuring essential coordination and support of medical care for patients.



Duties

The purpose of this position is to improve the quality of care to the empanel patient by coordination of medical care among primary and specialty teams, ensuring all patients receive standard of care, promoting self-management of chronic disease through helping patients to identify barriers to making healthful choices, helping patients providing coaching and guidance on positive health behaviors.

  • Assess the patient care needs for the Primary Care Medical Home (PCMH) patients to include triage of acute issues for determination of appropriate level of care.
  • Asses the delivery of nursing care to the panel of patients to proactively identify problems and opportunities for improvement in care to panel of patients.
  • Utilizes population health concepts to promote improved care for all patient on the panel. This includes use of iCare panels of patients to identify and stratify patients who would benefit from chronic disease management.
  • Provides direct care during face to face visits, telephone visits, and through secure messaging. This may include nurse only visits for the purpose of coaching and education, share medical visits with the provider, group education visits and group medical visits in collaboration with a provider.
  • Provides leadership in the implementation of planned changes to improve nursing services. Consults with primary care providers and other healthcare professionals on patients to coordinate diagnostic and therapeutic regimens for patients.
  • Provides patient and family education which include counseling and assisting the patient/family to understand and accept implications of care, diagnosis and treatment.

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