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NYC Health + Hospitals

Nurse Practitioner (PC)

NYC Health + Hospitals, New York, New York, us, 10261


Marketing Statement

Since 1875, South Brooklyn Health has established its reputation for clinical excellence and culturally competent care. It has designations as a Certified Percutaneous Coronary Intervention (PCI) Center, an Advanced Primary Stroke Center, an accredited Baby-Friendly Hospital, a U.S. News & World Report high performing hospital. The hospitals staff is as diverse as the patients they serve. Interpreter services can be provided at any time of the day or night in over 130 languages.

At NYC Health + Hospitals, our mission is to deliver high quality care health services, without exception. Every employee takes a person-centered approach that exemplifies the ICARE values (Integrity, Compassion, Accountability, Respect, and Excellence) through empathic communication and partnerships between all persons.

Purpose

Job Description

Plan, organize, direct, coordinate and evaluate chronic care services and support chronic illness care improvement activities based chronic disease collaborative initiatives in Primary Care and Ida G Israel. Work with the facility and collaborative teams to continue improvement of care delivery for those with chronic illnesses. Promote interdisciplinary collaboration, foster team work and champion chronic care excellence. Participate in the outreach, evaluation, assessment, education and triage of patients in collaboration with Attending Physicians participating in the care of patients with chronic diseases like Diabetes and Hypertension.

Specific Duties And Responsibilities

The Chronic Disease Coordinator is charged with and responsible for:

Work at our adult primary care clinics to improve the quality of chronic disease careFocus 70% of time on direct patient care and 30% on performance improvement responsibilitiesProvide direct clinical care, for patients with uncontrolled chronic conditions e.g., hypertension, diabetes, high cholesterol, Asthma, Arthritis, Cancer Screens, and Smoking Cessation. This can includeEducate patients about diagnosis, treatment, medications, and needed follow-upConduct follow-up visits for HTN management, diabetes medication titration, high cholesterol, Asthma, Arthritis, Cancer Screens, and Smoking Cessation, teaching on use of devices like continuous blood glucose monitorsNavigate patients through care management, required primary, secondary, tertiary care, and assist with access to all required lab, imaging, and path services, etcOutreach patients not engaged with care, order appropriate labs and medications as neededIdentify underlying challenges i.e. socioeconomic, cultural, physical or language barriersCollaborate with patients, families and care team to address barriers, using strategies such as motivational interviewing and brief action planningLiaise with social work department or Community Health Workers to develop strategies to address social determinants of health (e.g., homelessness or food insecurity)Organize group medical visits and moderate discussion to optimize peer-peer supportDocument care rendered in EMR and bill for services providedParticipate in performance improvement initiatives including Quality AcademyPresent chronic disease data at the Ambulatory Care Quality meeting. Broadcast plans via SBH Administrator, share performance, best practices and updates at Amb Care MeetingsManage Care/VBP gaps ensuring adequate documentation, coding, referral & order coordination for imaging, DM Education, collaboration with clinical pharmacists for medication management, dietary and weight management. Collaborate with VBP coach and Primary Care leadership to improve care gaps.Implement patient education materials, campaigns and forums for chronic disease prevention, preventative services, etc.Collaborate with central office staff in the Office of Population Health to implement chronic disease performance improvement initiatives.Report progress bi-weekly on facility chronic disease initiativesCoordinate and collaborate with facility clinical, nursing and administrative leadership to drive continuous performance improvement for chronic disease managementEducate ambulatory nursing staff on chronic disease initiativesMonitor adherence of ambulatory nursing staff to performance improvement plansTrack and share quality metrics with stakeholders across the facilityImplement OPH disease management toolkits to drive facility changeCoordinate with OPH and facility leadership to address barriers in achieving improvement goalsOther duties as assigned

Minimum Qualifications

A valid New York State license and current registration to practice as a Registered Professional Nurse issued by the New York State Department of Education (NYSED); andCurrent certificate as a Nurse Practitioner issued by the NYSED; andHolds, or obtains through facility orientation, a valid and current certification in Basic Life Support (BLS) through the American Heart Association (AHA).

Department Preferences

Strongly prefer National Board Certification in specialty in which you are assigned.

Strong computer skills: Microsoft Word, Excel and Power PointEpic proficiency preferredGood Organizational And Time Management Skills RequiredComplete the CDCES or BC-ADM credential within one year of employment, if possible.

How To Apply

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NYC Health and Hospitals offers a competitive benefits package that includes:

Comprehensive Health Benefits for employees hired to work 20+ hrs. per weekRetirement Savings and Pension PlansLoan Forgiveness Programs for eligible employeesPaid Holidays and Vacation in accordance with employees Collectively bargained contractsCollege tuition discounts and professional development opportunitiesMultiple employee discounts programs