Triage-Nurse

Community Memorial Hospital, Inc.; New York (NY); On-site; USD 55,104 - 68,880; Full time

Job summary

Community Memorial Hospital, Inc. is seeking an RN with 3–5 years of clinical nursing experience to join five outpatient Family Health Centers in Morrisville, Waterville, Munnsville, and Cazenovia near Syracuse.

You will manage transitions from hospital to primary care, coordinate post-acute care for high-risk patients, and support care coordination efforts. The role emphasizes patient education, collaboration with a care team, and data-driven quality improvement to improve outcomes and reduce

Qualifications

• RN with three to five years relevant clinical nursing experience.

Responsibilities

• Provides service to patients of Community Memorial Hospital five outpatient Family Health Centers (Morrisville, Waterville, Munnsville and Cazenovia, Sherrill).
• Responsible for managing a patient’s successful transition from hospital to primary care services. Manages post-acute care of patients at risk for poor health outcomes, frequent ER visits, and hospital readmissions.
• Coordinates with CMH Care Coordination team to identify high-risk, complex patients for program enrollment and communications with primary care to promote and maximize care coordination. Serves as a member of CMH Readmission Committee.
• Completes post-discharge workflow of telephonic follow-up within 48 hours, facilitating clinical care, patient access to appropriate services, referrals and primary care appointments within 14 days.
• Communicating and coordinating with all provider(s) and care team members to minimize fragmented care. Advocate for patients and supporting clinical teams to ensure delivery of appropriate, evidence-based care.
• Provide specialized nursing treatment, development of care plans, and education to patients with a patient-centric, collaborative approach.
• Address total individual needs including medical, psychosocial, behavioral, and spiritual needs; involve patient and support systems in decision-making.
• Assess educational needs related to disease process and home/community re-entry; apply teaching/learning theories to assist patients and families.
• Monitor quality and effectiveness of interventions with measurable goals.
• Access data from multiple sources to target outreach, education, and intervention.
• Provide clinical experience in an educator role for family health center nursing staff; participate in orientation and coaching of new staff.
• Facilitate Quality Improvement activities and collaborate on performance improvement programs and projects.

Skills

RN experience

Patient care

Communication skills

Motivational interviewing

Data analysis

Job description

Morrisville Family Health
3460 South Street
POB 1133
Morrisville, NY 13408, USA

Morrisville Family Health
3460 South Street
POB 1133
Morrisville, NY 13408, USA

Waterville Family Health
117 West Main Streeet
Waterville, NY 13480, USA

Waterville Family Health
117 West Main Streeet
Waterville, NY 13480, USA

Sherrill
803 Sherrill Rd
Sherrill, NY 13461, USA

Sherrill
803 Sherrill Rd
Sherrill, NY 13461, USA

• Pay or shift range: $40 USD to $50 USD
  The estimated range is the budgeted amount for this position. Final offers are based on various factors, including skill set, experience, location, qualifications and other job-related reasons.

Description

Responsibilities and Duties:

• Provides service to patients of Community Memorial Hospital five outpatient Family Health Centers (Morrisville, Waterville, Munnsville and Cazenovia, Sherrill).
• Responsible for managing a patient’s successful transition from hospital & long-term care to primary care services. Manages the post-acute care of patients at risk for poor health outcomes, frequent emergency room visits, and hospital readmissions.
• Coordinates with CMH Care Coordination team to identify hospitalized high-risk, complex patients for program enrollment and communications with primary care to promote and maximize care coordination. Serves as a member of the CMH Readmission Committee.
• Completes post-discharge workflow of telephonic follow-up within 48 hours, facilitating clinical care, patient access to appropriate services, referrals and primary care appointments with 14 days. Focuses on medication reconciliation and adherence, identification and rectifying gaps in care, assessment and support of patient’s ability to perform self-care, coordination of post-discharge appointments and services.
• Communicating and coordinating with all provider(s) and member(s) of the care team as needed to minimize fragmented care. Advocate for patient(s) and supporting clinical team(s) to ensure delivery of appropriate, evidence-based care.
• Provide specialized nursing treatment, development of care plans, and education to patients while exercising discretion and independent judgement; following established policies and procedures. Use a patient-centric, collaborative partnership approach to assist the patient with improved self-management. Utilizing proven processes to measure a patient’s understanding and acceptance of the proposed plan(s), his/her willingness to change, and his/her support to maintain health behavior change.
• Address the total individual, inclusive of medical, psychosocial, behavioral, and spiritual needs. Involve the patient and their support systems (i.e. caregiver, family, etc.) in the decision-making process.
• Assess the educational needs of the patient/caregiver as it relates to the disease process, alterations in function, and assimilation back into the home and community. Apply teaching and learning theories to assist patients and families with physical and emotional impact of body changes and chronic illness.
• Monitor quality and effectiveness of interventions to the population by setting long term and/or short-term specific, measurable goal(s).
• Accessing and systematically using data from multiple sources such as patient medical records, claims, and program metric reports to target recipient(s) and provider(s) for outreach, education, and intervention.
• Provide clinical experience in an educator role for family health center nursing staff. Participates in the orientation of new nursing staff and provides expert coaching and guidance through both formal and informal one-on-one teaching with nursing staff.
• Facilitate Quality Improvement activities that educate, support, nursing, regarding evidence-based care for best practice/National Standards of Care (Adapted from CMSA, 2010).
• Collaborate with Practice Manager and FHC Administration team in quality/performance improvement programs and projects, product evaluation, outcomes evaluation studies and/or clinical research.

Job Requirements:

• RN with three to five years relevant clinical nursing experience; including pediatric patients, behavioral health patients, and patients with chronic conditions.
• Organized and motivated by a fast-paced environment
• Able to manage multiple tasks/projects simultaneously
• Proficient in review and assess needs quickly
• Strong with the use of computer software tools and data files
• Comfortable with continuous change and self-initiating
• Maintain strict confidentiality
• Build effective and trusting relationships with patient/peers
• Use motivational interviewing and active-listening skills when assessing patient conditions, problems and interests
• Use conflict-resolution skills when reaching consensus about plans of care and treatment decisions
• Demonstrate confidence, compassion, political savvy, as well as attention to detail to apply these skills as decisions dictate
• Use data to analyze trends and to verify data
• Ability to promote programs and services to community
• Proficient in review of medical records and other patient care information

Qualifications

Skills

Behaviors

:

Motivations

:

Education

Experience

Licenses & Certifications

Required

BLS

Registered Nurse

Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor.