Registered Nurse - Nurse Care Coordinator

Job Description

Job Description

Description :

Do you want the chance to make a real and lasting difference in the lives of those in need? Healthcare for the Homeless is looking for a compassionate and self-motivated Registered Nurses (RN) to join our direct care team as Nurse Care Coordinators on a full-time basis. There is a 40 hour / week or a 30 hour / week schedule available. The Nurse Care Coordinator will ensure patients have access to care and services through the Health Care for the Homeless (HCH) program. This role will focus on addressing the complex medical and behavioral health needs of the uninsured, underinsured, those experiencing homelessness and housing insecure individuals by utilizing the nursing process to conduct comprehensive assessments and identify co-occurring medical, mental health, and substance use disorders. Additionally, the Nurse Care Coordinator will provide care for patients with substance use disorders participating in the Medication Assisted Treatment (MAT) Program. Responsibilities include care coordination, chronic disease management, counseling, and health education.

Responsibilities;

• Perform triage and rapid clinical assessments for patients who present at HCH shelter-based clinic and non-shelter-based clinic, in partnership with the HCH behavioral health team.
• Initiate appropriate emergency response in life-threatening or unusual situations to stabilize patients; promptly and directly notify the HCH provider(s).
• Assess and document patients’ vital signs, physical symptoms and chief complaints in preparation for their clinic visit.
• Perform comprehensive bio-psycho-social assessments and conduct mental health and substance use disorder (SUD) screenings using evidenced based tools.
• In collaboration with the interdisciplinary team, develop individualized care plans based upon nursing assessment as indicated. Provide health education and counseling to patients in support of self – care and health management goals.
• Based on the assessment, refer patients to the appropriate level and category of care within the multidisciplinary HCH team, and effectively communicate assessment findings and screening results to medical and behavioral health providers.
• Ensure all patients’ clinical assessments, diagnostic results and consult reports are up to date in the electronic medical record (EMR) in preparation for clinic visits with medical and behavioral health providers.
• Coordinate all aspects of care to ensure continuity of care within the HCH team and to ensure access to all required diagnostics, specialty care and services in the community.
• Coordinate discharge plans for each clinic visit; arrange referrals for diagnostic and specialty care, with support for transportation, escort, translation and medication assistance as needed.
• Perform nursing care interventions as ordered by the providers, and in support of the providers, for medication administration, point of care testing, and diagnostic procedures during each clinic session.
• As scheduling permits, participate in the Street Medicine program in collaboration with the HCH staff to identify, engage, and enroll individuals experiencing homelessness into HCH care.

MAT-Specific Patient Assessment & Care Coordination :

Work with the prescriber to obtain prior authorizations as needed

Requirements :

Equal Opportunity Employer : All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, marital or familial status, age, or mental or physical handicap.