Transitional Care Associate Jobs in Arizona (NOW HIRING)

Under general supervision of the Patient Centered Medical Home (PCMH) Manager, the Emergency Department (ED) Clinical Care Coordinator will work independently and in conjunction with multidisciplinary team members involved in coordinating care of ED patients at the Dilkon Medical Center (DMC). Responsible for the delivery of appropriate, timely, and beneficial care for patients by promoting quality cost‑effective health care outcomes in a seamless continuum of care. Working with the established standards of clinical care coordination, case management principles, and advance access principles. The coordinator demonstrates excellent clinical and critical thinking skills on clinical and operational issues. This is a clinical position and patient assignments will be taken when necessary. Upholds the principles of WIHCC’s Vision, Mission, and Value Statements. Maintains confidentiality of all privileged information at all times.

• Exemplifies professional nursing practice through expert clinical practice, strong leadership skills, and management activities.
• Provides clinical management to the ED department through coordination of patient care activities, procedures and flow of patients between various units.
• Functions as the coordinating resource for the nursing staff in the ED.
• Works directly with the ED staff to identify the care needs for patients throughout the continuum of care.
• Acts as liaison between ED staff, patients, and other departments to develop and ensure a smooth process for the safe and effective care of patients in the ED.
• Acts as a resource to nursing staff in problem solving and resolution of patient care issues.
• Collaborates with admitting, both in house and with outside facilities, to facilitate the plan for timely placement of admissions and transfers.
• Conducts post ED discharge calls on identified high risk patients and promotes transitional care management, assisting in primary care provider (PCP) follow‑up when indicated.
• Collaborates proactively with all interdisciplinary team members to facilitate and maximize patient health care outcomes.
• Develops and maintains competence to provide direct care to the ED patient population.
• Develops and maintains internal patient care database for continuous tracking and follow up for continuity of care for active management of ED patients.
• Coordinates multi‑disciplinary patient care conferences for high risk or complex patients as needed.
• Advocates for the patient/family at the service‑delivery level and at the policy‑making level fostering the patients/family’s decision making, independence, and growth and development.
• Maintains compliance with applicable laws, such as patient confidentiality, abuse reporting, principles of consent and advanced medical directives.
• Utilizes campus software packages and applications for ordering, scheduling, and tracking patient care.
• Utilizes best practice models to identify, incorporate or develop best practices for patient management.
• Participates in department, WIHCC teams and committees.
• Participates in the continued development of the role of case management and care coordination in the primary care – advanced access model.
• Integrates factors related to quality, safety, efficiency, and cost effectiveness in planning, delivering, monitoring, and evaluating customer care by promoting the most effective and efficient use of human and financial resources.
• Maintains regular attendance and punctuality.
• Requires completion of tasks or duties assigned by a supervisor.
• Upholds all principles of confidentiality and patient care to the fullest extent.
• Adheres to all professional and ethical behavior standards of the healthcare industry.
• Adheres to WIHCCs Personnel Policies and Procedures, departmental policies, rules, and regulations.
• Interacts in an honest, trustworthy and dependable manner with patients, employees, visitors, and vendors.
• Possesses cultural awareness and sensitivity.
• Maintains compliance with all Human Resources requirements.
• Performs other duties as assigned.

• Completion of an accredited nursing program and an unrestricted license as a Registered Nurse from any of the fifty states.
• Bachelor’s degree or higher in Nursing; Associate Degree Nursing with BSN completion within four years from date of hire is considered.
• Two years of clinical and/or ED nursing experience or two years as an RN supervisor or management experience.
• Previous case management experience and/or certification in case management (CCM) preferred.
• BLS, ACLS, and PALS required for employment in the Emergency Department.
• Bilingual skills in English and Navajo language preferred.
• Must maintain a valid unrestricted and insurable driver’s license.
• Must successfully pass a background investigation and maintain suitable requirements for a Child Care position. This position is considered as a Child Care position, which requires a satisfactory background check investigation and is subject to the requirements of the Indian Child Protection and Family Violence Prevention Act, as amended (henceforth referred as the ICPFVP Act).

• Knowledge of strong work ethics in the workplace.
• Knowledge of basic application of confidentiality.
• Knowledge of duties and responsibilities of the position.
• Knowledge of basic computer skills, e.g. Outlook, Word, Excel, PowerPoint.
• Knowledge of EHR, RPMS, iCare, and other WIHCC software programs in the performance of patient care and coordination.
• Knowledge of quality management and improvement processes to comply with internal and external accreditation standards (AAHC, CMS, Etc.).
• Knowledge of general medical procedures and the ability to anticipate complications and the indicated therapeutic interventions.
• Knowledge of clinical practices and ability to act as a resource for clinical personnel.
• Knowledge of effective teaching processes and principles in planning, providing and evaluating optimum health care.
• Ability to provide standard nursing care for patients throughout the age continuum.
• Ability to promote health care outcomes with currently accepted clinical practice guidelines.
• Ability to provide patient education and information on health assessment, disease process, medications, and treatment plans.
• Ability to perform job using theory-based nursing practice model, evidence‑based practices, and shared governance in a multidisciplinary team model.
• Ability to be dependable in attendance and job performance.
• Ability to meet attendance, overtime (if necessary), and other reliability requirements of the job.
• Ability to accept and learn from feedback.
• Ability to effectively communicate both in written and verbal.
• Ability to provide exemplary customer service at all times.
• Ability to interact positively with others and possess great interpersonal skills.
• Ability to multitask and perform well under pressure.
• Ability to have self‑confidence.
• Ability to be a great team player.
• Ability to accept and learn from supervisor/peer critique.
• Ability to be flexible and adaptable to the changing needs of the organization.
• Assesses patient needs and promotes health care outcomes using established clinical guidelines, protocols, and pathways.
• Provides appropriate follow‑up as directed or per established guidelines.

While performing the duties of this job, the employee regularly is required to walk; sit; use hands and fingers, handle, or feel; reach with hands and arms; and talk or hear. The employee frequently is required to stand; climb or balance; and stoop, kneel, crouch, or crawl. The employee is frequently required to taste or smell. The employee must occasionally lift and/or move up to 50 pounds.

Work is performed in an office setting or clinical work environment with a moderate noise level. Work environment may involve exposure to physical risks, such as blood borne pathogens and operating dangerous equipment or working with chemicals. Evening and/or weekend work may be required. Extended hours and irregular shifts may be required.

As required by P.L. 93‑638, absolute preference will be given to qualified Navajo applicants. If there is no qualified Navajo applicant, preference will be given to qualified American Indian applicants.