Clinical Support Director - Muleshoe Area Medical Center : Job Details

SUMMARY: This is a multi-functional position within the Leadership of the organization. The R.N. Clinical Support Director will coordinate a team-based care model to provide health services to individuals, through effective partnerships with staff, patients, their caregivers/families, community resources and their physician/mid-level. Facilitates a shared goal model within and across settings to achieve coordinated high-quality care that is patient and family centered. Collaboration with provider and other members of the patient centered care team to provide comprehensive care of the patient. This position is inclusive of, but not limited to, Swing Bed Coordinator, Chronic Care Manager, Discharge Planner, Activities Coordinator, and Director of Education.POSITION REQUIREMENTS:

• Knowledgeable of Medicare, Medicaid, and assistance programs.
• Customer service abilities including effective listening skills.
• Must be able to relate to and work with ill, disabled, elderly, emotionally upset, and at times, hostile people within the facility.
• Maintain discretion and confidentiality in communications.
• Knowledgeable of disease processes and appropriate activities to encourage resumption of normal activities and encouragement of self-care.
• Competent in medical terminology.
• Maintain discretion and confidentiality in communications.
• Knowledgeable about policies and procedures regarding reporting and release of protected health information (PHI).
• Competent in clinical skills and use of medical equipment.
• Knowledgeable of Infection Control and Prevention practices.
• Knowledge of licensing requirements, nursing practice act, statutes and rules applicable to nursing.
• Maintain certifications and continuing education requirements needed to perform job.
• Proficient in communication technologies (email, cell phone, etc.).
• Ability to speak a relevant second language preferred.
• Ability to identify and implement appropriate patient communication strategies and overcome accessibility barriers, as required.
• Demonstrates evidence of essential leadership, communication, education, collaboration, and counseling skills.
• Effective organizational skills and demonstrates ability to maintain accurate notes and records.
• Maintain certifications and continuing education requirements needed to perform job.

POSITION COMPETENCIES:

• Core values consistent with a patient/family-centered approach to care.
• Demonstrates professional and effective written and verbal communication skills.
• Demonstrates a positive, respectful attitude and professional customer service.
• Acknowledges patients' rights on confidentiality issues, always maintains patient confidentiality, and adheres to HIPAA guidelines and regulations.
• Proactively acts as a patient advocate, responding with empathy and respect to resolve patient/family concerns.
• Recognizes and responds to opportunities for improvement.
• Demonstrates continual learning skills, effects changes in approach to care based on established, evidence-based practice.
• Demonstrates professional practice behavior.
• Provides mentoring/coaching of other population health and care coordination team members.
• Cultivates effective partnerships, effectively collaborates with all practice providers (Physician, Nurse Practitioner, Physician Assistant and other licensed allied health team-members).
• Demonstrates understanding in use of IT resources and patient databases.
• Demonstrates effective delegation skills to streamline operational workflows and optimize inter-office resources.

DUTIES AND RESPONSIBILITIES:

• Provide a coordinated, strategic approach to detect early and manage effectively the chronically ill patient population.
• Implement an effective internal tracking system for identified patients.
• Ensures effective tracking of test results, medication management and adherence to follow-up appointments, including conducting and documentation of telephone calls.
• Coach patients/families toward successful self-management of their chronic disease.
• Utilize tools and documents that support and guide care process, collaborate with patient/family toward an effective plan of care.
• Assess patient and family's unmet health and social needs.
• Provide effective communications to improve health literacy.
• Participate in care planning based on mutual goals with the patient, family, and provider's emergency plan, medical summary, and ongoing action plan, as appropriate. Monitor patient adherence to plan of care and progress toward goals in a timely fashion, and facilitate changes as needed.
• Create ongoing processes for patients/families to determine and request the level of care coordination support they desire over time.
• Promote healthy behaviors in all populations and ensure navigation assistance with community resources.
• Facilitate patient access to appropriate medical and specialty providers as well as other care coordination team support specialists (e.g., Diabetes Educator).
• Cultivate and support primary care and subspecialty co-management with timely communication, inquiry, follow-up, and integration of information into the care plan regarding transitions-in-care and referrals.
• Serve as the contact-point, advocate, and information resources for patients, family, care team, payers, and community resources.
• Develop systems to prevent errors (e.g., effective medication reconciliation and shared medical records).
• Facilitate and attend meetings between patient, families, care team, payers, and community resources, as needed.
• Attend and actively participate in all Care Coordination related training and meeting activities (Health Coach certification, quarterly Regional Workshops, monthly cohort calls with other Care Coordinators and Coach).
• Participate in Patient Centered Medical Home related meetings and training activities, as needed.
• Participates in 1115 Waiver related meetings and activities, as needed.
• Miscellaneous duties as assigned requested or required.

RequirementsEDUCATION and/or EXPERIENCE:

• Current Registered Nurse Or License Vocational Nurse licensure.
• Previous experience in caring for chronic disease patients required.
• Previous Care Coordination, Case Management or Home Health experience preferred.
• 3-5 years experience in clinical or community health settings, preferred.
• Previous experience in health IT systems and data reports preferred.
• Previous experience with mobilizing community resources, navigating patients through the healthcare continuum, and working with disparate populations preferred.
• Basic Life Support (BLS) certificate.
• Advanced Cardiac Life Support (ACLS), highly recommended.
• Pediatric Advanced Life Support (PALS), highly recommended.
• Certificate of Competency as a Clinical Health Coach, highly recommended.

LANGUAGE/READING SKILLS:

• Communicate verbally and in writing in English.

MATHEMATICAL SKILLS:

• Competent in dosage calculations.

REASONING ABILITY: Responds to unusual or varied situations that are not covered by existing standards, procedures and precedents. WORK ENVIRONMENT: Regularly required to stand, walk, sit, ascend and descend stairs, possess ability to handle, finger or feel objects, tools or controls; reach with hands and arms.Frequently be able to lift 25 pounds from the floor to waist level and may occasionally be required to assist moving adult patients. Specific vision abilities include close vision and the ability to clearly focus vision. Specific hearing abilities using the stethoscope for breath sounds and Korotkoff sounds.