Zufall
PCMH Nursing Coordinator
Zufall, Dover, New Jersey, us, 07801
Welcome to Zufall Health!
Position Summary
The PCMH Nursing Coordinator works in collaboration with the patient, family, providers, clinical support team and office staff and within the team structure, to ensure the provision of patient-centered, cost effective, high quality care. Patients under the care of the Coordinator will be supported by the development of a multi-disciplinary care plan, self-management goals and referrals to both internal and external resources.
Essential Functions, Duties, and Responsibilities
Identify patients within the team with anticipated high cost care, recent hospital admission requiring transition of care from hospital to home, high utilization of services, complex medical needs or those at high risk for complications or exacerbation from diseaseLink patients with community resources to facilitate referrals and respond to social service needsUtilize referral protocols and agreements with subspecialists to meet patients' needs and achieve goals and objectives in their plan of careTrack and support patients when they obtain services outside the center such as the Emergency Department, hospitals and other subspecialistsFollow up with patients within a few days of an emergency room visit or hospital dischargeIn collaboration with providers, communicate test results and care plans with patients and familiesTrack completion of laboratory tests, diagnostic studies and referrals as directed by providers and in collaboration with clinical teamProvide relevant self-management support, including patient education, for patients with chronic illnesses as identified by clinical teamsIn collaboration with provider, provide skilled nursing services appropriate to the scope of a community health center including provision of wound careIn collaboration with the behavioral health team and provider, coordinate the clinical preparation and care for Medication Assisted Treatment for patients with a Substance Use DisorderWork with patients both in person and over the phone to remind and review their plan of care and progress towards their goalsIn collaboration with administrative staff and enabling services, assist patients with the process of determining eligibility and to obtain and maintain free pharmaceuticals through the Patient Assistance ProgramBe the system navigator and point of contact for patients and families, with patients and families having direct access for asking questions and raising concernsAddress patient and family concerns and initiate corrective action. Bring identified issues to the attention of supervisorAssist patients in problem solving potential issues related to the health care system, financial or social barriers (e.g., request interpreters as appropriate, transportation services or prescription assistance)Triage patients who present to the health center and who require evaluation for routine, acute, emergent, or urgent careHandle phone calls from patients seeking medical information and/or medical attention.Schedule appointments as the patient's condition requires answer questions, and provide limited health educationFurnish medical advice per approved triage reference booksProcess medication refill requestsCorrectly assess stat triage patient's vital signs and charts them accuratelyAssist the office staff to appropriately identify the patient's acute needs and direct that patient to receive the care requiredAssist in transfers to hospitalAssist in the collection of data and preparation of reports and registries for review by the QA/PI CommitteeEnsure timely documentation in Electronic Health RecordsParticipate in Performance Improvement/Continuous Quality Improvement activitiesAdhere to policies/safety practices established by the Zufall Health CenterMaintain confidentiality of all patient informationWork effectively with other members of the health care team to optimize interventions.Serve as subject matter expert in POS labs, duties of Medical Assistant, Clinical Competencies, Standing ordersAssess annual competencies for the Medical Assisting StaffOversee orientation of new Medical Assistants, assigning them to preceptors for orientation, tracking orientation progress through the use of the Medical Assistant Orientation checklist, provide feedback to Site Manager as necessaryWork with the CMA's, providers, DON and clinical pharmacist to maintain pharmacy stock, order medications, evaluate ordering history and make recommendations for changes to medication formulary to meet the needs of the providers and siteIn collaboration with DON, work with other sites as necessary to assist with MA training and Competency AssessmentMaintain/rotate the VFC/317 vaccine stock to prevent vaccines from expiring or running out. Order vaccines in a timely manner. Assist with maintaining the registry. Serve as subject matter expert on NJIIS and VFC/317 for both children and adultsPerforms other duties as assigned by Director of Nursing and Chief Medical OfficerKnowledge, Skills and Abilities
Possess thorough knowledge of practical nursing theory, standard practices, rules, and regulations related to nursing, knowledge of anatomy and physiology, and knowledge of aseptic techniqueExcellent customer focused interpersonal skills to interact in an effective manner with practitioners, the interdisciplinary health care team, community agencies, patients, and families with diverse opinions, values, and religious and cultural idealsExcellent verbal and written communication skillsBilingual in Spanish/EnglishAbility to anticipate primary care provider's needsExcellent computer skills, experience with electronic medical records a plusAbility to interact with patients, staff and outside agencies appropriatelyAbility to follow instructions, given either orally or in writingAbility to work independently or with little supervisionExcellent organizational skills such as problem solving, decision making, priority setting, and work delegationAbility to complete assignments in a timely mannerAbility to work as a team memberAbility to maintain HIPAA compliance, corporate compliance and client confidentialityEducation, Training and Experience
Licensed Practical Nurse or Registered Nurse trainingCurrent license Registered Nurse in the State of New JerseyOne to two years' experience in a clinical setting, including direct patient care and triage experiencePrior experience in an ambulatory care or outpatient clinic setting and case management experience preferredAs a condition of employment, we require that all staff are fully vaccinated against flu. Therefore, if hired during flu season (typically between September-May), all new employees need to be fully vaccinated against flu and are required to provide documentation of receiving flu vaccines upon hire.
Zufall Health an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, national origin, disability status, medical conditions related to pregnancy or childbirth, protected veteran status, or any other characteristic protected by law. Thank you for taking the time to apply!
Other details
Job Family ClinicalPay Type SalaryMin Hiring Rate $73,000.00Max Hiring Rate $80,597.90
Apply Now
Position Summary
The PCMH Nursing Coordinator works in collaboration with the patient, family, providers, clinical support team and office staff and within the team structure, to ensure the provision of patient-centered, cost effective, high quality care. Patients under the care of the Coordinator will be supported by the development of a multi-disciplinary care plan, self-management goals and referrals to both internal and external resources.
Essential Functions, Duties, and Responsibilities
Identify patients within the team with anticipated high cost care, recent hospital admission requiring transition of care from hospital to home, high utilization of services, complex medical needs or those at high risk for complications or exacerbation from diseaseLink patients with community resources to facilitate referrals and respond to social service needsUtilize referral protocols and agreements with subspecialists to meet patients' needs and achieve goals and objectives in their plan of careTrack and support patients when they obtain services outside the center such as the Emergency Department, hospitals and other subspecialistsFollow up with patients within a few days of an emergency room visit or hospital dischargeIn collaboration with providers, communicate test results and care plans with patients and familiesTrack completion of laboratory tests, diagnostic studies and referrals as directed by providers and in collaboration with clinical teamProvide relevant self-management support, including patient education, for patients with chronic illnesses as identified by clinical teamsIn collaboration with provider, provide skilled nursing services appropriate to the scope of a community health center including provision of wound careIn collaboration with the behavioral health team and provider, coordinate the clinical preparation and care for Medication Assisted Treatment for patients with a Substance Use DisorderWork with patients both in person and over the phone to remind and review their plan of care and progress towards their goalsIn collaboration with administrative staff and enabling services, assist patients with the process of determining eligibility and to obtain and maintain free pharmaceuticals through the Patient Assistance ProgramBe the system navigator and point of contact for patients and families, with patients and families having direct access for asking questions and raising concernsAddress patient and family concerns and initiate corrective action. Bring identified issues to the attention of supervisorAssist patients in problem solving potential issues related to the health care system, financial or social barriers (e.g., request interpreters as appropriate, transportation services or prescription assistance)Triage patients who present to the health center and who require evaluation for routine, acute, emergent, or urgent careHandle phone calls from patients seeking medical information and/or medical attention.Schedule appointments as the patient's condition requires answer questions, and provide limited health educationFurnish medical advice per approved triage reference booksProcess medication refill requestsCorrectly assess stat triage patient's vital signs and charts them accuratelyAssist the office staff to appropriately identify the patient's acute needs and direct that patient to receive the care requiredAssist in transfers to hospitalAssist in the collection of data and preparation of reports and registries for review by the QA/PI CommitteeEnsure timely documentation in Electronic Health RecordsParticipate in Performance Improvement/Continuous Quality Improvement activitiesAdhere to policies/safety practices established by the Zufall Health CenterMaintain confidentiality of all patient informationWork effectively with other members of the health care team to optimize interventions.Serve as subject matter expert in POS labs, duties of Medical Assistant, Clinical Competencies, Standing ordersAssess annual competencies for the Medical Assisting StaffOversee orientation of new Medical Assistants, assigning them to preceptors for orientation, tracking orientation progress through the use of the Medical Assistant Orientation checklist, provide feedback to Site Manager as necessaryWork with the CMA's, providers, DON and clinical pharmacist to maintain pharmacy stock, order medications, evaluate ordering history and make recommendations for changes to medication formulary to meet the needs of the providers and siteIn collaboration with DON, work with other sites as necessary to assist with MA training and Competency AssessmentMaintain/rotate the VFC/317 vaccine stock to prevent vaccines from expiring or running out. Order vaccines in a timely manner. Assist with maintaining the registry. Serve as subject matter expert on NJIIS and VFC/317 for both children and adultsPerforms other duties as assigned by Director of Nursing and Chief Medical OfficerKnowledge, Skills and Abilities
Possess thorough knowledge of practical nursing theory, standard practices, rules, and regulations related to nursing, knowledge of anatomy and physiology, and knowledge of aseptic techniqueExcellent customer focused interpersonal skills to interact in an effective manner with practitioners, the interdisciplinary health care team, community agencies, patients, and families with diverse opinions, values, and religious and cultural idealsExcellent verbal and written communication skillsBilingual in Spanish/EnglishAbility to anticipate primary care provider's needsExcellent computer skills, experience with electronic medical records a plusAbility to interact with patients, staff and outside agencies appropriatelyAbility to follow instructions, given either orally or in writingAbility to work independently or with little supervisionExcellent organizational skills such as problem solving, decision making, priority setting, and work delegationAbility to complete assignments in a timely mannerAbility to work as a team memberAbility to maintain HIPAA compliance, corporate compliance and client confidentialityEducation, Training and Experience
Licensed Practical Nurse or Registered Nurse trainingCurrent license Registered Nurse in the State of New JerseyOne to two years' experience in a clinical setting, including direct patient care and triage experiencePrior experience in an ambulatory care or outpatient clinic setting and case management experience preferredAs a condition of employment, we require that all staff are fully vaccinated against flu. Therefore, if hired during flu season (typically between September-May), all new employees need to be fully vaccinated against flu and are required to provide documentation of receiving flu vaccines upon hire.
Zufall Health an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, national origin, disability status, medical conditions related to pregnancy or childbirth, protected veteran status, or any other characteristic protected by law. Thank you for taking the time to apply!
Other details
Job Family ClinicalPay Type SalaryMin Hiring Rate $73,000.00Max Hiring Rate $80,597.90
Apply Now