Massac Memorial Hospital
  • 12-Aug-2020 to 11-Oct-2021 (CST)
  • Administration
  • Metropolis, IL, USA
  • Full Time

Health, Dental, Vision, Retirement, Life, Short Term Disability, Long Term Disability


RN Care Coordinator - Full Time

Summary: Responsible for quality reporting activities related to accountable care organization(s), the patient centered medical home(s) and care management services including, but not limited to, pre-visit planning, creating and monitoring a patient's care plan, medication management, referral management, self-management support and quality measure reporting and improvement.

Essential Job Duties:

  1. Pre-Visit Planning: Development of pre-visit plans with complete patient information prior to a scheduled follow-up visit for the care managed condition.
  2. Care Planning: In partnership with the patient and the care team design, implement and monitor individual patient care plans.  Ensure that treatment goals are assessed at each visit and assist the patient in addressing barriers to progress.
  3. Medication Management: Conduct medication review and reconciliation at planned care management visits (either in person or over the phone), care transitions, and following visits to specialists, emergency departments or hospitalization.  Ensure documentation of all prescription medications and over-the-counter medications, herbal therapies and supplements.
  4. Referral Management: Ensure that each care managed patient has successfully made an appointment and was seen by specialists as referred by their primary care provider. Ensure visit information is received from each specialty visit and incorporated into the patient's electronic medical record and is available for review by the patients primary care provider.
  5. Self-Management Support: Provide care managed patients with a written self-care plan that addresses the patient's condition, and includes goals and an action plan for monitoring self-care. Refer patients to community resources for education and support as needed.
  6. Commitment Monitoring: Ensure that all of the quality of care commitments made to the ACO are delivered by documenting and tracking each commitment and partnering with the Assistant Director of Ambulatory Operations to ensure each is carried out.
  7. Data Reporting: Collect and report all required data to the ACO in a timely and complete manner.
  8. Develop a quality improvement dashboard that tracks all of the quality metrics for the Care Management Program.
  9. Collect and report on each quality improvement measure in a timely and complete manner.

Qualifications: Registered Nurse with a minimum of five years in a healthcare setting; excellent verbal and written communication skills; ability to work independently and as a team member; strong interpersonal, listening and critical thinking abilities; excellent organizational skills.

 

Shift: Monday - Friday 8:00 a.m. to 4:30 p.m.

 

******MMH is an equal opportunity employer******

Massac Memorial Hospital
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