Integrated Care Team Nurse: Improve Patient Outcomes

HealthLinc; South Bend (IN); On-site; USD 42,000 - 66,000; Full time

Job summary

HealthLinc in South Bend, IN is seeking a Patient Care Team Nurse to continuously evaluate patient care systems, collaborate with the healthcare team, and report patient progress. This role emphasizes patient-centered care and requires close cooperation with medical staff to coordinate services across settings.

The position supports ongoing quality improvement initiatives, follows approved protocols, and aims to maintain efficient patient flow while educating patients and families as needed.

Responsibilities

• Participates in continuous quality improvement activities by evaluating patient care systems that may include standards, protocols, and documentation.
• Collaborates with the healthcare team to ensure continuity of patient care throughout the healthcare settings.
• Promotes effective communication among healthcare team members including patient, family and significant others.
• Performs assessment, data collection, obtain, review and analyze information in collaboration with the healthcare team members and others as appropriate.
• Conducts pre-visit planning by reviewing charts, following up on labs, and referrals as well as obtaining necessary orders from the provider.
• Identifies patient problems, physiological and psychological changes, deviations from normal, and identifies inter-relationships of problems, reports changes to health care providers
• Keeps care coordination records up to date
• Initiates, implements, and documents patient and family teaching and documents their response to teaching.
• Identifies unsafe patient environment and intervenes responsibly. Discusses situations with Pediatricians and Nurse Practitioners for development of emergency plan for patient and family regarding their health care
• Maintains open communication with Pediatrician, Nurse Practitioners, and other staff, reporting patient progress, abnormal diagnostic/assessment data, and notable health changes
• Assists patients and families in functioning at their optimum level.
• Regularly meets with Providers and other Patient Centered Medical Home team members to identify clinical problems and helps initiate appropriate solution.
• Assists in implementing and carrying out continuous quality improvement programs and activities.
• Coordinates services for patients and families utilizing other health related agencies and resources
• Obtains referrals to other physicians and specialists.
• Follows approved protocols/standing orders for patient care.
• Ensures that a productive and efficient patient flow occurs.
• All HealthLinc staff is committed to engage in quality improvement initiatives that align with and support Patient-Centered Medical Home (PCMH).
• Performs other duties as assigned.

Education

High School

Job description

HealthLinc in South Bend, IN is seeking a Patient Care Team Nurse to continuously evaluate patient care systems, collaborate with the healthcare team, and report patient progress. This role emphasizes patient-centered care and requires close cooperation with medical staff to coordinate services across settings.

The position supports ongoing quality improvement initiatives, follows approved protocols, and aims to maintain efficient patient flow while educating patients and families as needed.