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Exemption Status:

Exempt

Schedule Details:

Monday through Friday

Scheduled Hours:

8-4

Shift:

1 - Day Shift, 8 Hours (United States of America)

Hours:

40

Cost Center:

10020 - 3998 Cardiology Apps

This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.

Everyone Is a Caregiver

At UMass Memorial Health, everyone is a caregiver – regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 16,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other. And everyone, in their own unique way, plays an important part, every day.

I. Major Responsibilities:

1. Facilitates the entry of patients into the diagnostic and/or treatment system and coordinates their care including family involvement. Follows the patients throughout the continuum of health care services across multiple departments.

2. Assists patients in understanding their diagnosis, treatment options, recommended follow up and resources available.

3. Utilizes nursing process to comprehensively assess the patients’ physical and psychological sta-tus.

4. Evaluates progress of patients along the continuum and is responsible for professional and per-sonal modifications along with the healthcare team as appropriate. May assist with tracking of post care patients to ensure post treatment standards of care are met along with referrals. As necessary, ensures that patients receive clinical satisfaction surveys.

5. Coordinates and participates in multidisciplinary planning conferences, collaboratively assists with the development of patient summaries for use by care team.

Inpatient:

Work with inpatient heart failure team to identify patients and coordinate hospital care.Patient education prior to dischargeAssist with development of plan of care following discharge from the hospital.Coordination of patient care across the continuum of care including inpatient, outpatient, LTC, hospice, palliative care, and home care.Communicate regularly with physicians and advance practice providers regarding ongoing patient needs.Attend weekly team meetingsWork with cardiac bundle navigator for longitudinal care.

Outpatient:

Triage patient symptoms calls Proper assessment and triage skills to ensure patient is getting the level of care neededFollow up on interventionsDisease management:Post discharge telephone calls with documentationDatabase managementRemote monitoring surveillance (HeartLogic and CardioMEMS)Screen patients for additional support services such as Digital Health/MIHHF Clinic SupportAssist physician/APP in managing in baskets messagingAuthorize prescription refills as directed by supervising physicianCoordinate with Admin to schedule tests and procedures post MD/APP clinic.Provide patients with test results, assess, and evaluate patients understanding and refer to physician if necessary.Write orders, return to work notes (per physician verbal orders).Screen test results for abnormalities and need for immediate interventionFollow up on patients after complex clinic visit to ensure they understand and are following discharge orders. Monitor effectiveness of interventions.Accurately document providers’ verbal orders and implement plan.Prepare, explain, and assist with instructions regarding procedures and treatmentsSupport specialty clinics and follow up on testing, medication authorization

Other: 

Assist with ongoing work with CV quality department to ensure department is meeting regulatory and quality guidelines and goals.Maintain/develop patient database accurately, and able to interpret and analyze data to spot trends in care.Working in a fast changing environment to meet the needs of this complex patient population.Providing education to staff and affiliated providers about program.Demonstrate ability to work with confidential and controlled informationOther duties as assigned.

Qualifications:

2-5 years of Heart Failure RN experienceExperience with EpicExcellent written and verbal communication skills necessaryAbility to work in a strong team environmentFlexibility and strong work ethicExcellent assessment and documentation skillsEnthusiastic about working with disease managementProficient and accurate in documentation.Licensed RN, BSN preferred

II. Position Qualifications:

License/Certification/Education:

Required:

1. Bachelor’s degree in Nursing.

2. Current Massachusetts Registered Nurse licensure and registration.

Preferred:

1. Masters Degree in Nursing.

Experience/Skills:

Required:

1. Minimum of 5 years nursing experience.

2. Excellent teaching, consultation, and customer service skills.

3. Excellent critical thinking skills.

4. Demonstrates leadership experience.

5. Excellent verbal and written communications skills.

6. Computer literate with knowledge of Microsoft Office products.

Preferred:

1. Skilled with utilization of EMR and other software.

2. Experience with Project Management.

Heart Failure Disease Management Program RN patient navigator

Job Description

Responsibilities:

Inpatient:

Work with inpatient heart failure team to identify patients and coordinate hospital care.Patient education prior to dischargeAssist with development of plan of care following discharge from the hospital.Coordination of patient care across the continuum of care including inpatient, outpatient, LTC, hospice, palliative care, and home care.Communicate regularly with physicians and advance practice providers regarding ongoing patient needs.Attend weekly team meetingsWork with cardiac bundle navigator for longitudinal care.

Outpatient:

Triage patient symptoms calls Proper assessment and triage skills to ensure patient is getting the level of care neededFollow up on interventionsDisease management:Post discharge telephone calls with documentationDatabase managementRemote monitoring surveillance (HeartLogic and CardioMEMS)Screen patients for additional support services such as Digital Health/MIHHF Clinic SupportAssist physician/APP in managing in baskets messagingAuthorize prescription refills as directed by supervising physicianCoordinate with Admin to schedule tests and procedures post MD/APP clinic.Provide patients with test results, assess, and evaluate patients understanding and refer to physician if necessary.Write orders, return to work notes (per physician verbal orders).Screen test results for abnormalities and need for immediate interventionFollow up on patients after complex clinic visit to ensure they understand and are following discharge orders. Monitor effectiveness of interventions.Accurately document providers’ verbal orders and implement plan.Prepare, explain, and assist with instructions regarding procedures and treatmentsSupport specialty clinics and follow up on testing, medication authorization

Other: 

Assist with ongoing work with CV quality department to ensure department is meeting regulatory and quality guidelines and goals.Maintain/develop patient database accurately, and able to interpret and analyze data to spot trends in care.Working in a fast changing environment to meet the needs of this complex patient population.Providing education to staff and affiliated providers about program.Demonstrate ability to work with confidential and controlled informationOther duties as assigned.

Qualifications:

2-5 years of Heart Failure RN experienceExperience with EpicExcellent written and verbal communication skills necessaryAbility to work in a strong team environmentFlexibility and strong work ethicExcellent assessment and documentation skillsEnthusiastic about working with disease managementProficient and accurate in documentation.Licensed RN, BSN preferred

All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

We’re striving to make respect a part of everything we do at UMass Memorial Health – for our patients, our community and each other. Our six Standards of Respect are: Acknowledge, Listen, Communicate, Be Responsive, Be a Team Player and Be Kind. If you share these Standards of Respect, we hope you will join our team and help us make respect our standard for everyone, every day.

As an equal opportunity and affirmative action employer, UMass Memorial Health recognizes the power of a diverse community and encourages applications from individuals with varied experiences, perspectives and backgrounds. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, national origin, age, disability, gender identity and expression, protected veteran status or other status protected by law.

If you are unable to submit an application because of incompatible assistive technology or a disability, please contact us at talentacquisition@umassmemorial.org. We will make every effort to respond to your request for disability assistance as soon as possible.