RN Care Coordinator - Trauma & Emergency General Surgery Clinic
Vanderbilt University Medical Center
- Nashville, TN
- Permanent
- Full-time
This position is 40 hours week, 8am-4:30pm Mon-Fri (Flexible hours, but 5 days/week) in the Trauma Clinic. This role will be high functioning RN with a background in surgery or trauma, and have a skillset in case management or social work.Weekly responsibilities:
Proactively identifies and coordinates care for uninsured/underinsured
Complex care coordination across multiple service lines post discharge
Identifies patient post discharge care needs and analyzes insurance coverage/recommends alternate coverage based on needs
Manages all OORA/OON
Follows ASD/PTSD positive screens post-appointment for follow up
Advanced suicide ideation assessment skills
Attends discharge rounds PRN to proactively identify high readmission risk and manage risk factorsAssists in developing and meeting key Pillar outcomes and system improvement goals including financial, satisfaction, and clinical as the nursing component of the care coordination model. This position Improves outcomes by reducing all cause hospital readmissions and coordinating episodes of care among patients in a defined population or disease process. Participates in identification of appropriate patients; encourage patient and family engagement in self-care management; promote warm handovers to the next level of care by providing timely, pertinent information in a standardized way; conduct patient and family education on key elements of the patients' personal care plan by using the "teach-back" methodology and follow up phone calls; and assists the patient in navigating the healthcare system.SHIFT: 8:00 a.m. - 4:30 p.m.
Occasional Hybrid
Flexible Daily Hours that meets the needs of clinic patients.KEY RESPONSIBILITIES
- Coordinates the evaluation process of the defined patient population. May complete and document portions of the evaluation process, collaborating with other team members to ensure completion of all required information.
- Supports patient access by serving as a liaison between the referring provider's office and Vanderbilt provider.
- Interacts routinely and effectively with the clinical team to develop a collaborative plan for the coordination of patient care from the anchor hospitalization through the defined care episode.
- Develops and manages the processes related to pre-admission and post-discharge care transitions; establishes relationships/clinical pathways with providers/agencies to optimize care for defined patient population.
- Assists in the development and dissemination of patient education materials/information to include creation of customized medication grids with input from the pharmacist/team as needed.
- Assists with discharge/transition planning in collaboration with the multi-disciplinary team, actively engaging outpatient care providers by sharing hospital course, concerns, pending test results, learning needs, partnership opportunities etc. Coordinates handovers including outpatient care coordinators (disease management teams), home health care nurses, cardiac rehab, skilled nursing facilities, etc.
- Demonstrates reflective practice by constantly evaluating care coordination and supports the development of protocols for practice based on evidence
- The responsibilities listed are a general overview of the position and additional duties may be assigned.
- Evidence-Based Practice (Advanced): Recognizes, Implements, and evaluates practice changes based on published research. Demonstrates expertise in applying evidence-based practices to challenging and complex situations.
- RN Access Patient Education (Advanced): Demonstrates uppermost levels of patient education in practical applications of a complex nature. Possesses mastery of knowledge, training, and expertise to be capable of successfully delivering treatment planning services across the care continuum. Takes a lead role in complex situations when there is a need to achieve results. Actively participates in outside professional organizations and forums.
- Nursing Patient Assessment & Evaluation (Advanced): Demonstrates the uppermost levels of expertise in patient assessment and evaluations in challenging and complex situations. Conducts primary care patient interviews and physical examination. Often takes a lead role in complex patient care situations. Possesses expert knowledge, training and experience to mentor less experienced peers.
- Trend Analysis (Intermediate): Demonstrates mastery of trend analyses. Can recognize the impact and take into consideration the effect of seasonality and randomness. Has analyzed trends in detecting patterns that could lead to future problems and in forecasting future demand periods. Has worked in several areas that might include sales, marketing, quality, finance and manufacturing.
- Affordable High Quality Health Plan Options
- Dental and /or vision plan
- 403 (b) retirement plan
- Paid Time off (flex PTO)
- Tuition Reimbursement and adoption assistance (maximums applied)
- Short-Long term disability
- Subsidized backup childcare
- And many more... Ask us about our current inpatient nursing supplemental Pay Program!