Clinical CARE Coordinator ( Michigan Congenital Heart Center- Pediatric Cardiology

Position: CLINICAL CARE COORDINATOR ( Michigan Congenital Heart Center- Pediatric Cardiology)

Mission Statement
Michigan Medicine improves the health of patients, populations and communities through excellence in education, patient care, community service, research and technology development, and through leadership activities in Michigan, nationally and internationally. Our mission is guided by our Strategic Principles and has three critical components; patient care, education and research that together enhance our contribution to society.

Job Summary The MCHC Pulmonary Hypertension and Single Ventricle CCC provides comprehensive coordination of care to pediatric pulmonary hypertension and single ventricle patients and works collaboratively with colleagues across the MM health system and relevant outreach locations. The RN will coordinate nursing care to patients with complex cardiac conditions. It is required that the RN collaborates with other health care professionals:
Physicians, referring offices, schedulers, Cath lab nursing, diagnostic services, and pharmacists to provide a coordinated plan of care for our patients. He or she will review patient medical records from referring physicians and establish diagnosis and treatment plan with the medical staff. The coordinator may identify the need to order lab-work and other testing.
The MCHC pulmonary hypertension and single ventricle CCC will partner with other members of pulmonary hypertension and single ventricle teams to provide comprehensive care to our patients and families. Telephone management and excellent communication skills are essential to this position.
Evaluation of the daily scheduling of patients in coordination with each patient's individual testing needs requires expertise on the nurse's behalf. The RN must incorporate knowledge of cardiac procedures as well as individual patient testing and preparation requirements to ensure comprehensive care. The CCC works collaboratively with colleagues to develop, evaluate, and revise patient education programs and materials. Additionally, the CCC participates in data collection for the pulmonary hypertension and single ventricle programs and other QA/QI endeavors related to MCHC population.
This position has a 2 year initial funding period with plans to demonstrate value/return on investment.
Responsibilities
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• Provide coordinated care to pulmonary hypertension and single ventricle patients and families receiving care in the Michigan Congenital Heart Center (MCHC).
• Participate in all aspects of care coordination as a member of a collaborative and multi-disciplinary team.
• Communicate with referring clinicians and other healthcare team members.
• Provide professional nursing support in the management of pulmonary hypertension and single ventricle patients and associated chronic disease management. Provide skilled observations, triage, education and health assessments of patients including history, appropriate interventions and referrals.
• Provide patient-and-family-centered-care in the outpatient setting and tele-health management.
• Tele-health management includes triaging calls and in-basket messages from patients, families, clinicians, and other healthcare team members.
• Provide accurate and efficient documentation of nursing care
• Work in an integrated fashion with physicians, physician assistants, nurse practitioners, nutritionists, discharge coordinators, and other consulting services to provide high quality patient care
• Teaching and counseling for MCHC pulmonary hypertension and single ventricle patients via phone screening and in person clinic visits.
• Maintain patient flow in clinic, and support assistive staff as needed.
• Collaborate with clinicians, other health team members, and associated resource persons to provide continuity of care.
• Assist in the development and implementation…