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- Assesses the healthcare, educational and psychosocial needs of the patient/family and involves them in establishing a treatment plan based on realistic goals and interventions.
- Investigates healthcare options and facilitates communication among the patient, primary care provider and other members of the healthcare team to eliminate barriers and identify interventions for treatment.
- Applies age-appropriate learning principles to educate patients, family and other health care members on the role and purpose of Care Coordination, its processes, disease/case management programs and outcomes
- Serves as a resource to patients, families and other healthcare team members regarding disease management.
- Implements clinical interventions based on risk stratification and evidence-based clinical guidelines.
- Collaborates with primary care providers to enhance evidence-based clinical guideline adherence and promote best practice by initiating/adjusting therapies as directed by the practitioner and providing appropriate follow-up and monitoring as needed.
- Coordinates laboratory and diagnostic tests for all disease management programs.
- Collaborates with primary care providers to enhance evidence-based clinical guideline adherence and promote best practice by initiating/adjusting therapies as directed by the practitioner and providing appropriate follow-up and monitoring as needed. Facilitates/coordinates laboratory and diagnostic tests for all disease management programs.
- Maintains required documentation in EPIC for all disease management activities. Collects and enters data and patient information according to department standards.
- Attends and participates in professional and nursing continuing education programs and exploits professional development opportunities.
- Reviews the current literature regarding effective teaching/learning strategies and disease management strategies and incorporates the appropriate techniques into disease management practice.
- Maintains active involvement in post-discharge Transitions of Care coordination.
- Assists leadership in the design, implementation and evaluation of care coordination programs to support overall CPSL goals and strategic business strategies.
- Collects and prepares laboratory specimens (blood, urine, sputum, wound secretions) and completes associated paperwork (request slips, lab log, container labels, billing documents) to expedite laboratory studies with maximum accuracy and efficiency.
- Inserts, monitors, regulates and discontinues IV's as required by provider and per scope of practice.
- Administers medications and vaccines, including intradermal/skin testing, under the direction of a provider and per scope of practice.
- Performs other duties as required or assigned.
- Hours: 8 am to 4:30 pm (no weekends, holidays or on-call)
- Travel: Limited for meetings, orientation/training
- Required experience: 2 years of RN work experience
- Full benefits (health, dental and vision) starting on day one
- Three medical plan choices, including an expanded network for out-of-area employees and dependents
- Pre-tax savings plans with healthcare and dependent care flexible spending accounts (FSA) and a health savings account (HSA)
- Company-paid life insurance, short-term disability, and long-term disability coverage
- 401(k) plan that includes automatic Geisinger contributions
- Generous paid time off (PTO) plan that allows you to accrue time quickly
- Up to $5,000 in tuition reimbursement per calendar year
- MyHealth Rewards wellness program to improve your health while earning a financial incentive
- Family-friendly support including adoption and fertility assistance, parental leave pay, military leave pay and a free membership with discounted backup care for your loved ones
- Employee Assistance Program (EAP): Referrals for childcare, eldercare, & pet care. Access free legal guidance, mental health visits, work-life support, digital self-help tools and more.
- Voluntary benefits including accident, critical illness, hospital indemnity insurance, identity theft protection, universal life and pet and legal insurance
- KINDNESS: We strive to treat everyone as we would hope to be treated ourselves.
- EXCELLENCE: We treasure colleagues who humbly strive for excellence.
- LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow.
- INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation.
- SAFETY: We provide a safe environment for our patients and members and the Geisinger family.
rn - registered nurse coordinator - primary care - State College, PA , USA, United States - Geisinger Health
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Description
Location:Geisinger Medical Clinic Scenery Park
Shift:
Days (United States of America)
Scheduled Weekly Hours:
40
Worker Type:
Regular
Exemption Status:
Yes
Job Summary:
Serves in an expanded nursing role as part of an interdisciplinary team to promote preventative patient care, offer screening services, and coordinate disease management services while also providing primary clinical support to the provider, patient and their family to assist in the diagnosis and treatment of the patient's condition. Assists clinic team with triage of in basket messaging as needed and management of patient interaction with the clinic identifying patient needs, intervention pathways, clinical guidelines and diagnostic tests to develop individualized plans of care.
Job Duties:
The Primary Care Nurse Coordinator performs Medicare Annual Wellness Visits to support wellness planning and management of chronic disease. Also provides education visits including diabetic education and other chronic disease education for populations identified through wellness visits, patient registries or by the clinic provider.
Actively outreaches to clinic patient's post-hospital discharge for Transitions of Care coordination.
Our Primary Care RN Coordinators (PCNC) work within our Community Practice sites across the Geisinger territory. In total, there are presently 39 sites where our PCNCs provide support. On a typical day, our RN Coordinators will do adult wellness visits, transition of care calls, assist the provider(s) in answering appropriate messages, take care of normal lab values, place orders for follow-ups, place referrals, and more. The RN Coordinator will assist with office procedures such as IV, wound care teaching, education to the LPN staff, and patient education.
Our primary goal is to improve the health outcomes of our patients.
Benefits of working at Geisinger:
Graduate from Specialty Training Program-Nursing (Required), Bachelor's Degree-Nursing (Preferred)
Experience:
Minimum of 2 years-Nursing (Required)
Certification(s) and License(s):
Basic Life Support Certification - Default Issuing Body, Licensed Registered Nurse (Pennsylvania) - RN_State of Pennsylvania
Skills:
OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities.
We know that a diverse workforce with unique experiences and backgrounds makes our team stronger. Our patients, members and community come from a wide variety of backgrounds, and it takes a diverse workforce to make better health easier for all. We are proud to be an affirmative action, equal opportunity employer and all qualified applicants will receive consideration for employment regardless to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or status as a protected veteran.