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Patient Care Coordination Specialist
2 months ago
Position Overview:
This role involves the development and execution of thorough care strategies tailored to individual patients, families, and healthcare teams. The specialist will continuously assess and modify these strategies based on the evolving needs and strengths of the patients and their families.
Key Responsibilities:
- Formulate and implement detailed care plans in collaboration with patients, families, and healthcare teams, ensuring regular evaluation and updates based on patient needs.
- Facilitate communication and coordination among various healthcare providers, including outpatient clinics and inpatient services, to ensure comprehensive care.
- Monitor and assess patient health status through physical examinations, interviews, and review of medical histories.
- Provide education and support to patients and families, offering guidance and intervention during crises.
- Enhance care relationships by empowering families and ensuring access to necessary medical, psychological, and social services.
- Identify patients with chronic care requirements and maintain a chronic disease registry to inform care planning.
- Understand and navigate eligibility and referral processes for public and private services, ensuring patients receive appropriate support.
- Act as a liaison and advocate for families and community partners, maintaining strong relationships with relevant departments.
- Serve as a resource for healthcare staff, providing consultation on patient care issues.
- Develop and uphold policies regarding care coordination for patients with complex chronic conditions.
- Participate in quality improvement initiatives to enhance care delivery and patient outcomes.
- Engage in ongoing professional development to stay current with best practices in chronic disease management.
- Attend to specific clinical needs of patients as required, collaborating closely with primary care providers.
- Deliver comprehensive nursing care as needed and conduct community outreach to educate about chronic care issues.
- Create educational materials and learning opportunities tailored to community needs.
- Address community inquiries regarding chronic care patients and related issues.
- Complete all mandatory training as required by regulatory bodies.
- Support compliance with established healthcare standards.
- Perform additional duties as assigned.
Minimum Qualifications:
- Experience: A minimum of two years of experience as a Registered Nurse in clinical settings.
- Education: An Associate of Science degree in Nursing from an accredited institution.
- License: A valid and unrestricted Registered Nurse license in any U.S. State or Territory.
- Certification: Current certification in Basic Life Support (BLS) from the American Heart Association.
