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Job Description Summary:
This position is responsible for the programmatic development of the heart failure assigned program. Programmatic development consists of care coordination and outreach management. Care coordination responsibilities include, but are not limited to, the clinical management of specialized multidisciplinary care pathways. Outreach management responsibilities include, but are not limited to, organized communication between care continuum stakeholders (e. g physician specialists, primary and consulting physicians, other healthcare facilities, EMS, and System Service Lines). Other duties include research, education, compliance with regulatory requirements, and the implementation of annual strategic objectives.
Responsibilities And Duties:
50% Care Coordination:
Serve as a primary contact for clinical expertise related to the assigned programs.
Function as an active participant in all phases of the program care pathway development. Cultivate, implement, and monitor evidence-based standards of care for the program patients.
Establish and attain challenging clinical, operational, and quality performance goals. Coordinate with interdisciplinary team to advance the care of program patients.
Ensure appropriate post-discharge education with patients and families.
Evaluate the quality effectiveness of patient care and support services, analyzes, and ensures corrective action is taken as needed.
Performs initial, ongoing, and functional health status assessment as applicable to the population and/or individual.
Collects, analyzes and documents initial and ongoing subjective and objective data from patients, significant others, and communities.
Reviews data obtained by other members of healthcare team and incorporates into assessment.
Identifies and communicates assessment findings, both initial and ongoing, to appropriate people via referral, rounds, huddles, reports, and care conference, etc.
Uses assessment data to identify pertinent nursing diagnoses and collaborative problems.
Collaborates assessment findings with providers and members of healthcare team as appropriate.
Uses scientific knowledge, critical thinking skills, and effective interpersonal and teaching skills to provide nursing care.
Based on nursing diagnoses and collaborative problems, documents planned nursing interventions to achieve outcomes appropriate to patient needs including age, size, and development stage.
Initiates and/or coordinates care plans and individualizes critical paths/medical management plans.
20% Outreach Management:
Facilitate communication between referring hospitals, providers, and EMS relative to, but not limited to, appropriate patient information, training and education as assigned.
Community education on the programs as assigned.
Act as a liaison between patient, department, and the relevant OhioHealth service line at the system level.
20% Deployment and Maintenance of Program Imperatives:
Collaborate with appropriate departments to ensure real-time readiness and documented compliance with applicable regulatory, accreditation and licensing standards and requirements at all times and in all facets of the program.
Maintain knowledge and understanding of all current Joint Commission guidelines and objectives.
Assist in the development and implementation of annual strategic initiatives.
Collaborates with appropriate stakeholders to improve the program's value, including initiatives to lower the total cost of care.
Participates in process improvement activities.
5% Advancement of Program at the Local and National Level:
Participate in forums to exchange knowledge and information related to program advancement.
Maintain competency in best practice and emerging trends.
5% Clinical Care:
May participate in some aspects of clinical care as needed both in-person and virtually.
The major duties, responsibilities and essential functions listed above are not intended to be all-inclusive of the duties, responsibilities, and essential functions to be performed by employees in this job. Employee is expected to perform all other duties as requested by supervisor.
As a High Reliability Organization (HRO), responsibilities require focus on safety, quality and efficiency in performing job duties.
The job profile provides an overview of responsibilities and duties and is not intended to be an exhaustive list and is subject to change at any time
Minimum Qualifications:
Bachelor's Degree (Required)RN - Registered Nurse - Ohio Board of Nursing
Additional Job Description:
SPECIALIZED KNOWLEDGE

• Nursing or a related healthcare field (completed or in progress).
• Current Ohio licensure as RN.
• Experience in clinical program development and operations.
• A minimum of three Years of Experience in assigned program(s).
• Ability to work in a complex clinical and/or administrative system or program.
• Communication skills in order to lead, teach, and influence others.
• A high level of analytical ability.

Work Shift:
Day
Scheduled Weekly Hours :
40
Department
Disease Management
Join us!
... if your passion is to work in a caring environment
... if you believe that learning is a life-long process
... if you strive for excellence and want to be among the best in the healthcare industry
Equal Employment Opportunity
OhioHealth is an equal opportunity employer and fully supports and maintains compliance with all state, federal, and local regulations. OhioHealth does not discriminate against associates or applicants because of race, color, genetic information, religion, sex, sexual orientation, gender identity or expression, age, ancestry, national origin, veteran status, military status, pregnancy, disability, marital status, familial status, or other characteristics protected by law. Equal employment is extended to all person in all aspects of the associate-employer relationship including recruitment, hiring, training, promotion, transfer, compensation, discipline, reduction in staff, termination, assignment of benefits, and any other term or condition of employment