Responsible for managing, coordinating and integrating all Care Coordination services in a Patient-Centered-Medical-Home environment within CSV Medical Group Clinics. Provides Care Coordination services to patients based on person-centered acuity and leads and coordinates patient care coordination interdisciplinary team in a clinic setting. Contributes to a cooperative and accountable working relationship with other members of the Care Coordination system staff toward the goal of providing continuous services. Promotes optimal person-centered care that supports and empowers individuals, respects individual choices and meets health care needs of patients. Works side-by-side with clinic Medical Director in development of protocols and clinical-related processes. May work in traditional clinic setting and/or in a training environment (residency program).
BSN in Nursing, preferred.
Current New Mexico Nursing License
Considerable knowledge of health care facilities, policies and issues, and of the full spectrum of community patient care services. Considerable knowledge of health care and social management principles, practices and procedures of Patient Centered Medical Home as prescribed by NCQA standards. Ability to coordinate various functions and activities for maximum cooperation and integration of services providers and persons receiving care within a clinic for continuum of care services. Ability to direct, instruct and advise staff, and to receive and effectively react to day-to-day problems. Ability to utilize strong communication skills, both written and oral, and effectively demonstrate an interactive style of care coordination. Ability to understand and implement sensitivity and culture of care measures appropriate to a diverse population. Ability to understand and implement sensitivity and culture of care measures appropriate to a diverse population. Ability to work with various levels of the organization including clinical, financial, administrative and medical staff.
Minimum of five years of experience in a health care setting and related experience with interdisciplinary teams, performance improvement, care coordination and population health.
NATURE OF SUPERVISION:
System Director of Care Coordinator, CSVMG
- Bloodborne pathogen: Multiple settings and variable unpredictable situations including inpatient, specialty and primary care settings
Ability to move around settings of care. Requires close work, good vision, dexterity to write as well as to use computer keyboard. Ability to handle stressful situations.