Lead Care Coordination RN at Beacon Health System – South Bend, Indiana

Reports to the Executive Director and/or Director, Care Coordination. The Lead Ambulatory Care Coordination RN marshals the resources of the Outpatient Care Coordination Nursing team ensure that the group is able to achieve the goals of the department and entity which are aligned with the Accountable Care Organization and Value-Based contracts for Beacon Health System. As such, the Lead Ambulatory Care Coordination RN provides support and structure for the front-line nursing staff on this team to facilitate high quality, cost-effective care.

The Lead Ambulatory Care Coordination RN acts as the administrative representative and nursing leader for this team of Ambulatory Care Coordination Nurses. Collaborates with other professional, clinical and ancillary staff in providing quality care to patients. Ensures that workflows and care management protocols are optimized for maximal effectiveness to meet Department and Entity goals. Ensures that staff have the training and knowledge to efficiently follow workflows and processes. Provides at-the-elbow support for Care Coordination Nurses to execute workflows.

MISSION, VALUES and SERVICE GOALS

• MISSION: We deliver outstanding care, inspire health, and connect with heart.
• VALUES: Trust. Respect. Integrity. Compassion.
• SERVICE GOALS: Personally connect. Keep everyone informed. Be on their team.

Assures that Care Coordination Nursing staff are providing quality patient care by:

• Reviewing, interpreting and administering processes for each workflow carried out by Care Coordination staff.
• Reviewing individual cases with Care Coordination Nursing staff, providing coaching, guidance and decision-making support as needed.
• Recognizing and addressing concerns in a timely manner, investigating to define problems, intervening when immediate attention is needed and reporting results to appropriate person.
• Talking and listening to Coordinators, patients, families and members of the health team.
• Ensuring effective communication between Care Coordination Nursing teams and other disciplines and stakeholders involved in the care of designated patients both internal and ancillary to the department.
• Identifying additional training, resources, programs or support that Care Coordination nurses require to accomplish patient-level goals.
• Organizing regular connection and communication with Primary Care Providers and office personnel to ensure effective collaboration with the Coordination team.

Manages resources by:

• Contributing to unit, department and organization level Performance Improvement Plans and Strategy Implementation planning as requested.
• Reviewing and maintaining productivity goals for Care Coordination nursing roles.
• Reviewing and aligning sources of incoming patient referrals.
• Assigning patient cases to individual team members for care with a focus on timeliness and collaboration.
• Maintaining clinical knowledge and providing direct patient care coordination with a self-assigned caseload as staffing patterns demand.
• Ensuring that patient Care referrals are assigned timely to the correct Coordinators and other disciplines needed to achieve goals.
• Communicating problems or concerns with regard to quality, cooperation, communication or technology.
• Collaborating with Departmental Leadership on performance appraisals.
• Providing coaching and direct assistance to co-workers, orienting and training new personnel (including temporary staff) to duties and validating knowledge, skills and abilities of staff.
• Ensuring that workflows, processes, documentation and interactions are compliant with coding requirements, applicable law and regulations for services being rendered.

Performs Professional Practice by:

• Ensuring that individualized care plans are created which includes goals and prioritized nursing approaches/measures derived from the referral and health needs of the patient.
• Ensuring that Transitional Care is managed effectively for patients of the System who require this service.
• Accept responsibility for individual nursing actions and continued competence of the team.
• Maintains each patient’s right to privacy by protecting confidential information unless obligated by law to disclose the information.
• Manages a small, self-assigned caseload.

Performs other functions to maintain personal competence and contribute to the overall effectiveness of the department by:

• Serving on appropriate committees, councils or task forces as requested.
• Extracting, Tracking and reporting key metrics.
• Coaching Care Coordinators on job related tasks.
• Collaborating with other key members of the healthcare team.
• Completing other job-related duties and projects as assigned.

ORGANIZATIONAL REQUIREMENTS

Associate complies with the following organizational requirements:

• Attends and participates in department meetings and is accountable for all information shared.
• Completes mandatory education, annual competencies and department specific education within established timeframes.
• Completes annual employee health requirements within established timeframes.
• Maintains license/certification, registration in good standing throughout year.
• Consistently utilizes appropriate universal precautions, protective equipment, and ergonomic techniques to protect patient and self.
• Adheres to regulatory agency requirements, survey process and compliance.
• Complies with established organization and department policies.
• Understands and ensures compliance with applicable laws and regulations pertaining to the services rendered by the Ambulatory Care Coordination Nursing team.

Commitment to Beacon's six-point Operating System, referred to as The Beacon Way:

• Leverage innovation everywhere.
• Cultivate human talent.
• Embrace performance improvement.
• Build greatness through accountability.
• Use information to improve and advance.
• Communicate clearly and continuously.

Education and Experience

• The level of knowledge, skills and abilities require the successful completion of a Baccalaureate Degree in Nursing with a current RN license in State of IN. A minimum of five years of related clinical experience is required. Direct experience in Care Coordination, Case Management, Transitional Management, Patient Navigation or similar roles is required. Remote, outpatient, virtual and chronic care management experience is preferred.

Knowledge & Skills

• Strong knowledge of nursing care practices, procedures, and techniques within the assigned team and workflows.
• Familiarity with insurance guidelines to support value-based, cost-effective care.
• Proficient in relevant computer systems and use of organizational resources.

Leadership & Problem-Solving

• Demonstrates leadership skills to provide constructive feedback, guide peers, and support system-level decision-making.
• Strong analytical and problem-solving abilities to address immediate issues and identify patterns or trends requiring action.
• Adaptable and flexible in managing workload and supporting team and departmental functions.

Communication & Interpersonal Skills

• Effective verbal, written, and listening communication skills.
• Strong interpersonal skills to build respectful, cooperative relationships with patients, families, physicians, staff, and external partners.
• Ability to effectively manage relationships across diverse groups; serves as a professional role model.

Organization & Planning

• Well-developed organizational skills to plan, coordinate, and prioritize activities.
• Ability to manage time efficiently and perform effectively in a fast-paced environment.

Working Conditions

• Works in various environments including patient care areas with frequent changes in job demands.

Physical Demands

• Requires the physical ability and stamina to perform the essential functions of the position.
• Travel required.
• Clear communication and speaking voice for telephone speaking required.