Job Information
Brockton Hospital Homeward Bound RN Coordinator in Brockton, Massachusetts
Signature Healthcare is Southeastern Massachusetts’ premier local provider of quality, personalized medical services. We are comprised of the award-winning not-for-profit Signature Healthcare Brockton Hospital; Signature Medical Group (SMG), a multi-specialty physician group of more than 150 physicians practicing in 18 ambulatory locations and Brockton Hospital School of Nursing, a private, co-educational institution of nursing education. We believe our distinctive Signature Healthcare team approach is the way healthcare should be: medical professionals across many locations communicating and collaborating, taking advantage of technologies and resources to make a difference in the lives and health of our patients.
The RN Coordinator for the Homeward Bound program will assist with the care and management of the high risk Signature Healthcare patient population especially in the area of chronic illness. These patients are at risk for frequent admissions and emergency department visits, poor quality of life and poor outcomes. The Coordinator will manage via telehealth the weekday reporting of patient health parameters, liaison with SH PCP’s and specialists, nursing students and faculty to assist with implementation of the Homeward Bound program. The incumbent will make home visits as needed and coordinate the LunchExpresSONs meal delivery program for the Homeward patients.
Key Responsibilities’:
Determine patient eligibility and desire to enroll in Homeward Bound
Coordinate enrollment and management with other disciplines including but not limited to SH PCP, Physician Specialist, case management, patient navigators and social workers
Initially visit all patients admitted to the Homeward Bound program prior to student visits and as needed thereafter. Facilitate equipment delivery and patient education regarding equipment use.
Monitor telehealth information on a daily basis
Respond to and report information that falls outside of the established protocols to referring physician or designee
Maintain desired census in program by enrolling new patients and discharging those who are stable
Cross-train other RN Coordinators to monitor telehealth during his/her absence from Homeward Bound
Maintain weekly patient spreadsheet for internal use only
Document all home visits and problems with disease management and/or compliance in patient’s medical record
Assist in maintaining a database for Homeward Bound patients.
Collaborate with SH/BHSON and area Schools of Nursing (i.e. Dean/Chair/Team Coordinator, nursing faculty and students), to manage student clinical placement in the Homeward Bound program
Participate in pre-clinical and/or post-clinical conference with students and faculty as needed
Provide current patient information to faculty/students before each clinical experience
Coordinate student “shadowing” visits to Signature Healthcare outpatient offices and to the VNA as needed
Make home visits and /or phone calls during the School of Nursing especially during scheduled school breaks.
Provide teaching/counseling to patient and family members regarding disease management as needed
Coordinate the ordering and delivery of meals to Homeward Bound patients enrolled in the meal delivery program
Schedule patients for office visits to address issues of compliance/progression of disease or other problems that are difficult to manage over the phone.
Function as a resource to other health professionals in order to ensure continuity of care.
Review updated protocols annually with Associate Dean or designee.
Attend all COPD Homeward Bound meetings as scheduled by Associate Dean or designee
Communicate regularly with telehealth support specialists to resolve issues and monitor updates
Review monthly invoice to assure accuracy
Demonstrate respect and regard for the dignity of all patients, families, visitors, and fellow employees to ensure a professional, responsible, and courteous environment.
Commit to recognize and respect cultural diversity for all customers (internal and external).
- Communicate effectively with internal and external customers with respect of differences in cultures, values, beliefs and ages, utilizing interpreters when needed.
Perform other duties as assigned
Required Knowledge and Skills:
Demonstrate understanding of complex disease management.
Knowledge of evidenced-based chronic disease nursing practice required
Demonstrate interest in assisting faculty with the promotion of students achieving learning outcomes
Previous experience using clinical protocols to make decisions for adult patient required.
Demonstrate excellent verbal, written and computer skills
Portuguese or Spanish speaking desired but not required
Ability to achieve cognitive, organization and emotional maturity to deal effectively with multiple tasks, stresses, deadlines, difficult situations and or patients.
Open to feedback, and open to a changing environment which requires flexibility to scheduling and department assignment.
Demonstrate accountability/dependability as evidenced for example, by attendance record, completion of mandatory and clinic based competencies within an established time frame; by meeting deadlines and completing required work.
Education: Graduate of an approved RN school of nursing. Bachelor of Science in Nursing required.
Experience (Type & Length): Must have previous experience providing care to adult patients in an acute facility. Desirable two years in homecare with basic knowledge of telehealth. Experience in ambulatory setting with telephone patient management skills desired. Experience with nursing student education preferred
Certification/Licensure: Current licensure to practice nursing in the state of Massachusetts, BLS required and ACLS preferred.
Software/Hardware: Proficient in Allscripts and Meditech