Chronic Care Management RN Coordinator

Requirements

• Requires a diploma or degree form an accredited school of nursing.

• One to two years’ experience in a clinic or hospital setting preferred.

• Must have knowledge of motivational interviewing, chronic care management, and quality initiatives within the primary care setting.

• Must have current and valid Registered Nurse License from the State of Wisconsin.

• Current Basic Life Support (BLS) certification required.

• Basic proficiency in word processing and Excel programs; software proficiency covering a variety of health care / clinical record applications. Super User for at least 1 year; with experience in develop reports with in the EMR.

Work Hours

We are seeking a full-time (36 hours/week) RN to work four days per week from 7:30am-5:00pm.

Job Summary

Responsible to serve the patients with in the Chronic Care Management Program.  The RN will act as an extension of the primary care providers care plans, supporting patients in successful self-management of their chronic disease, optimizing health outcomes, and improving the overall patient experience.   The goal of this program is to re-engage patients who have not actively been seeking care, or whom have not actively been focusing on managing their chronic disease. Performs and educates staff on a variety of direct patient care duties in compliance with physicians' orders and appropriate protocol with in the Chronic Care Program. Performs a variety of indirect patient care duties under the supervision of the Director of Clinic Nursing and Quality. Reviews and prepares clinical records prior to clinic dates to ensure physicians' notes and corresponding reports are available for the reference by the specialist.

Essential Job Functions and Responsibilities

This list of duties and responsibilities is not all inclusive and may be expanded to include other duties and responsibilities as management may deem necessary from time to time.

1. Performs patient screening assessment and provides nursing care in the clinic or procedure room as appropriate including interviewing the patient to obtain their medical history and chief complaint, performing medication reconciliation and obtaining patients' vitals.
2. Develop and maintain care plans with patients in collaboration with PCP, pharmacy, and other key team members.
3. Prepares the patient for exams and/or procedures, provides patient education related to planned procedures, and ensures necessary consents are obtained.
4. Performs diagnostic testing, such inhaler in-check testing.
5. Makes contacts to appropriate care areas to schedule patients for follow-up tests and/or procedures.
6. Performs routine maintenance and cleaning of clinic equipment as appropriate.
7. Transfers patients between bed, chairs, and transfer devices.
8. Positions patient/equipment, monitor vitals, change linens as needed.
9. Performs all required paperwork and communicates with patient care team members, patients, and families.
10. Operates computer and communication devices.
11. Prepares/sets up or remove ancillary equipment and retrieves or stores supplies as indicated.
12. Provides patient care in urgent/emergent situations.
13. Performs CPR on patients during code before arrival of additional team members.
14. Provides education to clinical staff and providers on how to improve chronic care patients and outcomes within their practice on a routine basis.
15. Collaborates on a routine basis with other entities involved with Chronic Care Management, such as pharmacy, diabetes education, respiratory therapy, care coordinator at hospital, etc.
16. Collaborates with Director of Clinic Nursing on quality initiatives and assists in achieving goals with providers’ guidance.
17. Adheres to Southwest Health’s value-based behavior standards.
18. Understands and adheres to Southwest Health compliance and HIPAA standards as they appear in the Corporate Compliance Policy, Code of Conduct and Conflict of Interest Policy.
19. Performs other duties and responsibilities as requested or required.

Contact Information

Southwest Health
Attn: Human Resources
1400 Eastside Rd
Platteville, WI 53818
Phone: (608) 342-0993
Email: hr@southwesthealth.org
Fax: (608) 342-5015