CARE COORDINATOR/POPULATION HEALTH

Located in the heart of Idaho’s picturesque countryside, Steele Memorial Health Center, is a small, community centered rural hospital dedicated to providing compassionate and high quality care to our patients. We pride ourselves on fostering a supportive collaborative work environment that values every team member. If you’re seeking a fulfilling career where you can make a real impact in a tight-knit community, we’d love to have you join our team.

Check out all that Salmon, Idaho has to offer at the link below!

Salmon, Idaho Experience

Facilitates, coordinates, and oversees the transition of patient care across the continuum of care. The Care Coordinator provides education, and support to patients and families. Provides navigation of the healthcare system, and empowers patients to participate in their healthcare decisions and treatments. Through documentation and oral communication, essential information is shared with the healthcare team members to facilitate the patient’s care and treatment along the continuum. The main goal of public health nurses is to help prevent disease and reduce health risks at the population level through evidence-based care and education. The role of a public health nurse is to promote public wellness. In this capacity, nurses focus on helping underserved and at-risk individuals gain access to the care they need.

Duties:

• Initiate assessment of the patient and family across care settings (e.g. home, hospital, care facility, clinic) based on the patient's diagnosis, understanding of care plan, psychosocial and emotional needs.
• Implement an effective internal tracking system for identified patients
• Make rounds across settings to assess patient educational and functional needs and to determine patient preference for care.
• Coach patients/families toward successful self-management of their chronic disease
• Develop a plan of care encompassing patient and family shared decision making and concepts of the Transitional Care Model
• Facilitate patient access to appropriate medical and specialty providers as well as other care coordination team support specialists
• Educate patients about available support services and help them access care
• Cultivate and support primary care and subspecialty co-management with timely communication, inquiry, follow-up, and integration of information into the care plan regarding transitions-in-care and referrals
• Serve as a liaison between patient, family, primary care provider, and others involved in care plan to coordinate care across setting and ensure continuity of care
• Ensure effective tracking of test results, medication management, and adherence to follow-up appointments
• Evaluate the impact of therapeutic interventions on the patient's care and navigation through the healthcare system
• Facilitate and attend meetings between patients, families, care team, payers, and community resources as needed
• Provide community education and outreach related to Transitional Care and Care Coordinator program
• Attend and actively participate in all Care Coordination related training and meeting activities (Health Coach certification, quarterly Regional Workshops, monthly cohort calls with other NRACO Care Coordinators and Coach)

Requirements:

• Current Idaho licensure as an RN, or LPN and/or current Certified Medical Assistant
• 3-5 years' experience in adult care in settings including, but not limited to, physician clinic, inpatient, case management or homecare/hospice
• Previous experience in caring for chronic disease patient preferred
• Ability and willingness to demonstrate positive interpersonal relations in dealing with physicians, patients, patient families, visitors, all medical cneter employees and community agencies in a professional manner
• Leadership competencies to include planning and organizing, problem solving, informing, consulting, counseling, supporting, education and networking
• Proficient in communication technologies (email, cell phone, etc)
• Proficient in Microsoft Office
• Previous experience with health IT systems and data reports preferred
• Effective organizational skills and demonstrates ability to maintain accurate notes and records
• Ability and willingness to work with patient's needs and preferences across care settings by mobilizing community resources and navigating patients through the healthcare continuum
• Ability to identify and implement appropriate patient communication strategies

At Steele Memorial Hospital we prioritize maintaining a healthy work-life balance, allowing our employees to enjoy their personal lives while pursuing their professional goals.

• Competitive salary and comprehensive benefits package, including health, dental, vision, life & disability and 457 retirement
• Health insurance benefits include access to certain services at our facility free of charge
• Maintaining a healthy work-life balance is cultivated through flexible employee work scheduling, Wellness porgram with potential health deduction savings of up to $1,100 annually and our generous Paid Time Off policy
• Student loan repayment options for eligible candidates

Experience the beauty of rural Idaho with outdoor activities like white water rafting, year-round fishing in the infamous Salmon River, hiking, and skiing right outside your door!