This team member works collaboratively with physicians, mid-level providers, staff and other health care professionals to provide a medical home and care coordination function across the health care continuum focusing on enhancing the patient experience and supporting the medical home. Is an integral member of the health care team who works to ensure safety, best practice and high quality standards of care are maintained across the continuum. Responsibilities include assisting the multidisciplinary team in developing and coordinating a wide range of self-management support and chronic-care management activities for the clinic’s affected patient population. Focus will be on care connections management applicable to the assigned medical home offices. Success will be measured by the results of the process and outcome performance measures of the population of patients in the clinic. This position supports the patient centered medical home concept by working closely with the clinic and the care connections team members to develop systems and promote effective self-management of chronic-care and assist patients with navigating the healthcare system. Position will serve as a coach for multiple medical home offices to continually evaluate and enhance systems to support patient experiences and enhance care coordination. Focus will be to enhance and sustain the medical home in recognized offices.
At Novant Health, one of our core values is diversity and inclusion. By engaging the strengths and talents of each team member, we ensure a strong organization capable of providing remarkable healthcare to our patients, families and communities. Therefore, we invite applicants from all group dynamics to apply to our exciting career opportunities.
Required Experience: Minimum of five years clinical experience in hospital, home health, or community setting with a recent focus on acute and/or chronic disease management.
Case management experience preferred.
Required Licensure/Certification/Registration: Current LPN licensure in appropriate state, current valid state driver's license.
Additional Skills Required: Broad clinical knowledge base of multiple diseases and expected outcomes. Working knowledge of effective teaching techniques, applying adult learning principles. Ability to demonstrate coordination of appropriate educational materials for patients and their support systems. Knowledge of good business English, Spelling, and Math. Demonstrates appropriate professional nursing skills in the provision of preventive health maintenance and/or treatment of illness. Demonstrates a working knowledge of Novant Health and the physician office setting to act with providing connections across the system. Demonstrate appropriate clinical leadership skills as evidenced by previous work related activities and performances. Demonstrate the ability to work under the direction of the RN to assess and evaluate understanding of disease processes, treatment plans and/or lifestyle changes. Demonstrate appropriate communication, negotiating and networking skills. Demonstrate sound knowledge and appropriate decision-making skills for designated patient populations. Demonstrate appropriate organization skills. Demonstrate the ability to provide program specific outcomes. Demonstrate the ability to assess self Refer to the Life Support Training Policy NH-HR-3096
LP1550 1 learning needs and seek ways to meet own professional development by proactively educating self, participating in orientation and staff development activities, maintaining knowledge of clinical practice, issues, trends, technology and available community resources, and uses policies and procedures appropriately.
It is the responsibility of every Novant Health team member to deliver the most remarkable patient experience in every dimension, every time.
- Our team members are part of an environment that fosters team work, team member engagement and community involvement.
- The successful team member has a commitment to leveraging diversity and inclusion in support of quality care.
- All Novant Health team members are responsible for fostering a safe patient environment driven by the principles of "First Do No Harm".
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