Job Summary :
Acts as a patient advocate. Guides patients through the clinical care system, establishing contact with new patients and / or family members, or caregivers.
Understands the clinical care options for patients and directs them to healthcare services within the organization, at outside facilities and within the community for timely treatment and recovery.
Actively identifies and addresses population and patient specific barriers to care that might keep the patient from receiving timely and appropriate treatment.
Connects patients with resources, healthcare and support services in their communities. Supports the physician and interdisciplinary team in facilitating patient care with the underlying objective of enhancing the quality of clinical outcomes and patient satisfaction.
Implements day-to-day care management interventions for identified clinic patients.
Job Requirements :
Education and Work Experience :
- Bachelor's Degree in Nursing (BSN) : Preferred
- Clinical experience, preferably in managed care, disease or care management : Preferred
- Experience working with electronic medical records (EMR) : Preferred
Licenses / Certifications :
- Registered Nurse (RN) licensure in the state of practice : Required
- Nurse Practitioner (NP) licensure in state of practice : Preferred
- Certified Case Manager (CCM) or Chronic Care Professional (CCP) certification : Preferred
Essential Functions :
Assists patient and family in identifying and accessing appropriate institutional and community resources and coordinating appointments.
Implements appropriate care intervention and follow-up to ensure patients receive timely care, preventing delays and access to appropriate services and follow up instructions from managing physicians.
Interacts with other hospital departments and third party payers in fulfilling the needs of the patients.
Serves as primary point of patient intake and conducts patient triage. Makes initial and ongoing assessments of patient needs (clinical, emotional and social) and makes appropriate recommendations or referrals for care.
Facilitates the timely completion and confidential reporting of diagnostic testing results to patients and families with interpretation, as well as to ordering clinicians through active tracking of ordered tests.
Coordinates long-term follow-up and tracking of patient outcomes according to established Clinic protocols.
Collaborates with the team of patient, family, and healthcare providers in providing patient care in a safe, healing, humane, and caring environment.
Provides learning opportunities for patients / family members and team members. Directly provides health information to patients, families, and treatment team.
Promotes awareness and represents the clinic within the community increasing awareness of services provided, conducting screenings, providing community education, and other community outreach.
Documents coordinator and patient interactions in electronic or hardcopy chart in a manner consistent with hospital standards.
Creates reports from patient data such as volumes and outcomes. Monitors, analyzes, and reports to clinic governing body clinical and operational key indicators and identifies opportunities for performance improvement
Performs other job-related duties as assigned.
Organizational Requirements :
Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations, including, but not limited to, measles, mumps, flu (based on the seasonal availability of the flu vaccine typically during October-March each year), COVID-19 vaccine (required in CA, HI and OR) etc.
as a condition of employment, and annually thereafter. Medical and religious exemptions may apply.