RN, Triage and Care Navigation

Position Overview: Describes the overall purpose of the position or why the position exists

The Nursing Care Coordinator supports the Patient Service Center and other clinical team members by triaging and assessing the signs and symptoms presented by patients over the phone. The Nursing Care Coordinator will assist with the transition of care of patients upon discharge from the hospital by connecting them with follow-up appointments and resources to improve overall health.

Essential Duties and Responsibilities: The following description is a general representation of the essential duties and responsibilities of the position.

• Perform telephone triage to assess patient symptoms and problems. Appropriately advise patient and refer to other clinical providers to assure optimal outcomes. Enter documentation into EPIC EMR at the end of each call to ensure accurate records.
• Obtain baseline data on patients including medical history, vital signs, lab tests, and health education. Assess patient problem, develop, and implement patient care plan. Educate patients based upon health, illness, and self-care practices to promote positive lifestyle choices and improved health habits. Develop and present courses on related topics to patients and community residents as requested.
• Support patients' transition from acute or long-term care facility by coordinating follow-up care and appointments, referring to community partners for resources, and other tasks aimed at improved Social Determinants of Health.
• Recognize social determinants of health and partner with internal and external resources to improve patient health. Serve as member of Patient Center Medical Home team to collaborate with other team members.
• Provide education to patients based on specific health or psychosocial problems identified in alignment with current protocols to empower patients in managing their health and wellness.
• Other duties as assigned.