Inpatient Heart Failure Care Coordinator

4 days ago


Boston, Massachusetts, United States Tufts Medical Center Full time
Job Overview

This position plays a critical role in coordinating the transition of care for patients with heart failure, working closely with Case Management to ensure a seamless transition from one healthcare setting to another.

Key Responsibilities
  • Delivers education to patients and caregivers, including teach-back interventions, to ensure they understand their clinical condition, treatment, and postoperative course.
  • Collaborates with multidisciplinary providers to achieve exceptional patient outcomes and experiences.
  • Identifies eligible inpatients using established program criteria and delivers education to patients and caregivers.
  • Supports non-cardiology primary providers with HF guideline-directed medical therapies plans, including liaising with pharmacy.
  • Collaborates with other members of the inpatient care team to develop discharge care plans and coordinates post-discharge care to ensure a seamless transition.
  • Communicates closely with patients' PCPs and post-acute care providers regarding post-discharge care expectations.
  • Develops a plan for scheduled check-ins with patients and caregivers to ensure they are fully informed and supported during the transition period.
Requirements
  • Bachelor of Science degree in Nursing
  • Registered nurse with current unrestricted Massachusetts state license
  • Heart failure nurse certification highly desirable
  • Minimum of 5 years of clinical nursing experience working with heart failure cardiology patient population

Tufts Medicine is a leading integrated health system bringing together the best of academic and community healthcare to deliver exceptional, connected, and accessible care experiences to consumers across Massachusetts.



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