RN, Lead Care Coordinator

Job Summary:

The Registered Nurse, Lead Care Coordinator operates under a philosophy in which a registered nurse is accountable for planning, coordinating, and maintaining continuity of patient care while maintaining a relationship with the patient, family, and provider throughout the continuum of care. This position provides focus in assisting patients through the healthcare system by acting as a patient advocate, coach, and navigator.

Education, Training or Degree Required: (indicate preferred or required)

• Graduate of an accredited school of nursing with an associate's degree in professional nursing (required)

License/Registration/Certification Required:

• Current RN licensure within the State of Minnesota (will be primary source verified by HR)
• CPR certification (required)

Knowledge, Skills & Abilities: (indicate preferred or required)

• Prior experience as a Registered Nurse (preferred)
• Experience with health care technology clinical applications (preferred)
• Knowledge of health care practice (required)
• Ability to work with a diverse patient population (required)
• Demonstrated problem solver and self-starter (required)
• Ability to work independently without direct supervision (required)
• Strong critical thinking skills (required)
• Ability to respond to common inquiries or complaints from patients/customers (required)
• Ability to define problems collects data, establish facts, and draw valid conclusions (required)
• Ability to effectively deal with complex patients, family members, and care team members (required)
• Excellent interpersonal skills (required)
• Able to read, analyze, and interpret medical records, including lab results, radiological results, doctor orders, and progress notes (required)
• Able to maintain privacy and confidentiality (HIPAA) (required)
• Excellent organizational and time management skills (required)
• Able to work effectively in a team environment (required)
• Knowledge of local social service resources or skills to acquire and use this knowledge and information expeditiously (required)

Essential Duties & Responsibilities:

• Leads the process of maintaining Certified Health Care Home status at all clinics (Olivia, Hector, and Renville).
• Reviews provider schedules and individual patient charts and assist the care team in coordinating care for visits and for future healthcare needs of patients in the registry
• Applies motivational interviewing skills, care coordination and coaching principles to the care of patients with chronic and complex conditions.
• Assesses patient's situation, develops a comprehensive care plan, and updates it after regular contact with patient.
• Documents all patient contact in the electronic medical record.
• Provides an effective communication link between patient and medical staff, including relaying messages from providers, gathering information from patients for providers, etc.
• Manages medication refills for patients.
• Coordinates with the medical staff to ensure that care management services are provided to patients with complex medical and/or psychosocial concerns.
• Meets with patients, primary care and behavioral health providers, and other staff as needed to develop and coordinate treatment plans; meets with patient family members if needed.
• Interfaces with and refers patients to other supportive services as appropriate.
• Works with the medical staff to develop, implement and carry out programs in chronic disease management for patients, with such problems as diabetes, asthma, congestive heart failure, hypertension, and depression, based on chronic disease management model.
• Serves and functions on population health committees.
• Assists in coordination of care with nursing homes, pharmacies, insurance companies and other providers in the community. Ensure that information goes when and where it is needed.
• Uses registry and other information to inform care team members of preventive care required for patients whose care this person is coordinating.
• Ensures that all patients are tracked, and data entered systems for follow-up and reporting.
• Ensures that disease and other registry data entry is up to date and use registry reports to organize plan of care for complex patients on assigned panel.
• Participates in team decisions regarding treatment.

ABOUT OLIVIA HOSPITAL & CLINIC

Located in west central Minnesota, Olivia Hospital & Clinic is one of the leading employers in Renville County. We offer a competitive base salary with incentives, excellent retirement plans, a generous benefits package, a state-of-the-art medical center, and on-the-job training! If you're ready to make a difference, we're ready to meet you!

Olivia Hospital & Clinic is part of HealthPartners, a large health care organization spanning Minnesota and western Wisconsin. The HealthPartners care system includes a multi-specialty group practice that serves more than 1.2 million patients. Together, we're living our values every day to promote the health and well-being of the central Minnesota community.

We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.