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The Ambulatory RN - Care Coordinator is a vital member of the healthcare team responsible for ensuring seamless and high-quality care for patients in an ambulatory setting. This role involves both direct patient care and administrative responsibilities, with approximately 60% of time dedicated to patient-facing duties. The RN will support ambulatory physician clinics by seeing patients with complex and chronic disease that require additional support during outpatient visits. They will be involved in working with patients to develop and execute care plans, provide patient education, and work collaboratively with interdisciplinary healthcare team members to optimize patient care and experience.
Job Responsibility:
Ensuring seamless and high-quality care for patients in an ambulatory setting
Supporting ambulatory physician clinics by seeing patients with complex and chronic disease
Working with patients to develop and execute care plans
Providing patient education
Working collaboratively with interdisciplinary healthcare team members to optimize patient care and experience
Engaging in population appropriate communication
Giving clear instructions to patients/family regarding treatment
Involving family/guardian in the assessment, initial treatment and continuing care of the patient
Identifying any physical limitations of the patient and deploying intervention when necessary
Recognizing and responding appropriately to patients/families with behavioral health problems
Interpreting population related data and planning care appropriately
Identifying and responding appropriately to different needs resulting from, unique psychological needs or those associated with religious / cultural norms
Performing treatments, administering medication or operating equipment safely
Recognizing and responding to signs/symptoms of abuse or neglect
Acting as an expert clinician and role model in providing quality patient care
Utilizing the nursing process for direct patient care and assisting the staff with assessment, planning, implementation, and evaluation of patient care needs
Conducting thorough assessments of patients’ health status during clinic visits
Documenting nursing history and assessment for assigned patients, initiating referrals based on patient needs
Collecting basic level and advanced patient data
Maintaining awareness of comfort and safety needs of patients during their ambulatory appointment
Responding to life-saving techniques based on nursing standards, policies, procedures, and protocol
Providing accurate hand-off report when patients are moved between ambulatory areas and/or between ambulatory and inpatient areas
Recognizing and reporting changes in patient conditions and abnormal labs or results
Performing POC testing assessments as needed
Initiating and implementing individualized patient care plans in collaboration with other healthcare providers
Collaboratively developing and utilizing patient care pathways that ensure consistent quality of care for patients
Demonstrating competency in administering medications, perform wound care, and provide other direct nursing interventions as needed
Completing nurse visits and documents timely and accurately
Assisting with minor procedures and diagnostic tests
Monitoring patients for changes in condition, report findings to the healthcare team, and adjust care plans accordingly
Recruiting patients for studies
Assisting and collaborating with staff nurses in quality assurance
Meeting new patients to introduce self and explain role
Demonstrating ability to establish priorities of care based on individual patient assessments and the needs of the patients assigned
Demonstrating critical thinking and accountability in evaluating and implementing physician orders
Ensuring timely nursing documented with exceptional accuracy according to hospital policy and procedures
Maintaining positive, professional, and cooperative demeanor throughout all interactions
Maintaining a calm demeanor during emergent or challenging behavioral situations with patients
Meeting with patients and families to identify educational needs
Educating patients and their families about health conditions, treatment plans, medications, and self-care techniques
Reassessing for understanding and re-educating as needed
Applying current nursing literature in teaching techniques and guiding standards of care in patient and family education
Serving as a expert patient educator for disease-based and clinic-based care teams
Documenting patient/family/designee teaching and response appropriately
Facilitating seamless transitions of care by coordinating referrals, scheduling follow-up appointments, and ensuring timely access to services throughout continuity of care
Communicating effectively with patients regarding test results, treatment plans, and follow-up care
Addressing patient concerns and providing support and guidance throughout their treatment journey
Anticipating changing needs of patients and families based on care plan and acting proactively to reduce delays in care, reduce financial toxicity, and increasing patient satisfaction
Participating in interdisciplinary team meetings to discuss patient care
Collaborating with social workers, dietitians, and other healthcare professionals to address the comprehensive needs of patients
Serving as liaison to other departments and organizer for interdepartmental projects
Participating in transitions of care planning
Documenting plan of care reflective of collaborative practice with other health care team members
Supporting prior authorization for medication and diagnostic tests
Serving on nursing and hospital-wide and unit-based committees that influence the delivery of patient care
Assisting with developing and revising policies and procedures for nursing practice
Assisting with implementing evidence-based practice in the unit
Working collaboratively on performance improvement system wide
Demonstrating the nurse’s role as a member of the healthcare team and promotes accountability, responsibility, and commitment regarding patient care standards
Serving as a resource within his/her own specialty for all members of the healthcare team
Orientation and other education programs as assigned
Serving as a preceptor and/or mentor for nursing students, clinical interns, and other healthcare professionals as needed and identifies opportunities for observation or clinical experiences
Remaining current in research to area of clinical nursing practices
Participating and contributing to staff meetings
Maintaining confidentiality of information
Sustaining an understanding of regulatory requirements and accreditation standards
Monitoring safety and departmental policies and procedures
Working with department managers, nurses and nursing leadership and multidisciplinary representatives to identify and share safety best practices
Demonstrating an understanding of legal and regulatory issues (HIPPA, EMTALA, regulatory agencies, UC, legal P&P) impacting the care delivery and reimbursement process
Utilizing MIDAS effectively to report safety concerns
Able to escalate appropriately
Requirements:
Associate's Degree - Nursing
Current Registered Nurse (RN) license in the state of Ohio
Minimum of 2 years of nursing experience in an ambulatory or outpatient setting