Care Coordinator RN

GENERAL SUMMARY 

Manages services between the Integrated Care team and the community ensuring that both current diseases, as well as preventative and health promotional needs, are addressed as part of the holistic health approach. Ensures consumers have access to CHCS services relating to mental health and/or substance abuse and reports on reasons consumers were unable to obtain access. Connects consumers with resources and provides referrals to other programs. Supervises the Peer Support Specialists. Conducts center-wide training on Integrated Care services and group services.

ESSENTIAL DUTIES & RESPONSIBILITIES

•  Coordinates services between the Integrated care team and community services as needed to ensure that both current disease, as well as preventative and health promotion needs are addressed as part of the holistic, whole –person, culturally-sensitive health approach.
•  Establishes and maintains routine collaborative meetings between Integrated Care and system partners toward achieving benchmark standards and improving patient care.
•  Educates patients about health issues relevant to their care, community health resources, insurance information, financial assistance, pharmaceutical services, etc.
•  Participates in Quality Improvement activities, including data collection, tracking, and analysis.
•  Participates in various workgroup and committee activities to support departmental and organizational efforts to improve quality of services.
•  Supervises the work of staff and interns, as appropriate. Provides feedback and performance evaluations.
•  Provide professional recovery-oriented nursing care to individuals by performing assessments regarding the physical and behavioral health status of the client, completing nursing diagnosis, developing a plan of care, and evaluating consumer's responses to nursing interventions

•  Maintain pharmaceutical oversight of medication samples for specified units participating in the program through assigned unit level staff, maintaining accurate account of stock medications, controlled substances, and consumer medications.
•  Establish and maintain routine collaborative meetings between Integrated Care and system partners toward achieving benchmark standards and improving patient care.
•  Educate patients about health issues relevant to their care, community health resources, insurance information, financial assistance, pharmaceutical services, etc.
•  Synthesize information from treatment records, risk stratification, and other sources to assess program enrollees. Apply evidence-based clinical guidelines for behavioral and physical health issues, in addition, knowledge of care coordination techniques in assessing the needs of recipients and determining interventions to address those gaps.
•  Demonstrate excellent customer service and collaborate with physicians, providers, consumers, staff members, visitors, staff, and the health care community.
•  Collaborate with Health Home Team and treating providers using available data, such as exams/assessments scores, participant evaluations, and service observations in order to identify health and wellness needs and develop and implement care coordination plan to address treatment barriers.
•  Creation of informational tools and resources for clients and staff on mental health, physical health, and integrated health services
•  Maintains a variety of records and completes reports.
•  Development and coordination of all wellness programming (on-site and off-site), including promotion of activities, tracking attendance, evaluations, and topic. Delivery of wellness education programs.
•   Participate in Quality Assurance and Quality Improvement activities, including data collection, tracking, and analysis.
•  Provides culturally responsive and trauma-informed services.
•  Performs other related duties as required.

MINIMUM ENTRANCE QUALIFICATIONS 

Education and Experience

•  Current Registered Nurse Certification to practice in the State of Texas 
•  Two (2) years of nursing experience

Licenses or Certifications

•  Current Registered Nurse Certification or LPC, LMSW license

Other Requirements

•  Must maintain a valid driver’s license and automobile insurance coverage, be able to travel as needed, and be able to meet on a consistent basis the driving record requirements of the Company’s auto insurance carrier if you drive your vehicle during company business
•  Must maintain required credentials and mandatory training requirements to ensure compliance with all State regulations and CHCS policies

PREFERRED QUALIFICATIONS 

•  Bachelor’s degree or higher in Nursing from an accredited school of nursing
•  Previous case management experience preferred
•  Bilingual (English / Spanish)
•  Experience with or knowledge of well-ness oriented trauma-informed care
•  Previous lead or supervisory experience preferred

SUPERVISION

•  Supervises the work of staff and interns, as appropriate. Provides feedback and performance evaluations.

COMPETENCIES FOR SUCCESSFUL PERFORMANCE OF JOB DUTIES

Knowledge of:

•  Federal, State, and local laws, rules, or regulations in area of nursing practice
•  Wellness programming
•  Care coordination plans
•  Applicable software applications
•  Modern office procedures, methods and computer equipment

Skill in:

•  Mediation and counseling
•  Organization and time management
•  Performing a variety of duties, often changing from one task to another of a different nature
•  Performing basic mathematical functions such as addition, subtraction, multiplication, division, percentages, and ratios

Ability to:

•  Comply with and participate in Quality Assurance and Quality Improvement processes
•  Create informational tools and resources for clients and staff
•  Effectively communicate, both verbally and in writing
•  Establish and maintain effective working relationships
•  Maintain accurate and complete records
•  Meet schedules and deadlines of the work
•  Understand and carry out oral and written directions
•  Accurately organize and maintain paper documents and electronic files
•  Maintain the confidentiality of information and professional boundaries