Community Healthcare Nurse Coordinator

JOB DESCRIPTION

The Community Health Nurse Coordinator is a comprehensive role that has various responsibilities and will encompass leadership. Providing the day to day needs with 340B and The Pharmacy Connection Program, addressing patient care gaps and follow up needed, Chronic Care Management, and will have direct patient intake as needed for coverage needs. This position will report directly to the Clinical Managers, while working closely with Chief Nursing Officer.

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES

The Pharmacy Connection:

• Responsible for coordinating and completing medication assistance referrals ordered by all CAHN providers and all aspects of The Pharmacy Connection Program (TPC).
• Coordinates all patient medication assistance referrals to include the following: obtaining and entering demographic data where necessary, verifying prescriptions, medical records information; insurance information; physician records and notes and other information as assigned, acquiring and verifying third party information, obtaining and arranging appointments, tracking medications with the electronic medical record (EMR).
• Enters all appropriate data into assigned prescription assistance software.
• Collaborates with prescriptions (Rx) software programmers to ensure use of the most up to date version & coordinates integration with CAHN IT Manager where warranted.
• Performs initial assessment of patient’s eligibility for services, to include financial data, monitors patient status and update clients accordingly.
• Collaborates with the medical staff and other disciplines responsible for patient care to develop, implement, monitor, and evaluate appropriate resources and referrals to meet the prescription needs of patients and their families.
• Contacts patients upon obtaining authorizations and/or appointments.
• Arrange Rx referral appointments ensuring proper paperwork is given (mail and/or electronic) to the patient.
• Track Rx appointment “no-shows” in the patient’s EMR and submits a monthly report to the Chief Nursing Officer and Clinical Managers as directed.
• Maintain direct communication with the provider and patient regarding the most appropriate Rx and update in reference to recalls, etc.
• Maintain & track all “return to stock” medications and provide all nursing team members and Physicians with an updated list where warranted.
• Make appropriate notations in the EMR and bring to the attention of the ordering Provider any problems regarding obtaining prescriptions to include: patients who do not pick up their medications as required and/or patients who have been released from the CAHN Rx Connection Program.

340B Program:

• Overseeing compliance, coordination of various departments, ensuring the program’s efficiency in providing affordable medications within regulatory requirements.
• Coordinate with pharmacy staff, healthcare providers, and administrative personnel to ensure and execution of the 340B program.
• (Outside Pharmacies) Monitor orders, to ensure maximizing program benefits, etc., (In-house Pharmacy) - work with our Pharmacist In Charge (PIC).
• Document in multiple platforms (Pharmacies, Multiview).
• Conduct regular audits and assessments to ensure program integrity and identify areas for improvement.
• Will set on organization committee as designate monthly/quarterly.
• Will participate in 340B University Conferences as assigned.

Chronic Care Management:

• Coordinating care plans, conducting patient assessments, and monitoring patient progress.
• Collaborating with healthcare teams, facilitate communication through multidisciplinary approach to optimize patient outcomes and enhance the quality of care provided.
• Ensuring compliance with Medicare guidelines.

Gaps in Care:

• Validate data from various sources such as EclinicalWorks (eCW) and UDS reports, and payer portals (insurers).
• Concurrent review of patient’s clinical information for efficiency and reporting to insurance entity through their secure portal needed gaps.
• Coordination of follow up care for any missing gaps.
• Providing patient education provided related to need(s).
• Employ effective use of knowledge, critical thinking, and skills to advocate quality care and enhanced quality of life.
• Maintain accurate records of all patient related interactions.
• Work in an intensive, fast-paced environment with minimal supervision.
• Ability to stay organized and interacts well with others in any situation.

Direct patient intake:

• Provide assistance to nurses and providers as directed or if coverage needs arise.
• Always maintaining thorough documentation, reporting, and record-keeping to demonstrate program compliance and outcomes.
• Take initiative in all areas to gain knowledge and strive for improvement.
• Conduct other duties with care coordination and patient navigation & administration as assigned by the CNO, CMO, or any other member of the Senior Management Team.

Leadership

• Preferred to have a minimum of 3 years of broad medical terminology & healthcare/pharmacy experience.
• Preferred to have 3 years of case management in the medical field, and have completed a Pharmacy Technician course and/or received certification.
• Conduct in-services regarding the program policies and procedures.
• Submit monthly report by the 5th of each month outlining measurable outcomes, challenges, and productivity goals for the proceeding months for each program.
• Conduct an annual in-service to the CAHN Board of Directors as per the Chief Executive Officer’s directive.
• Monitors trends and implements strategies to assist patients with accessing appropriate level of care & scan the plan of action into the patient’s EMR.
• Attend and actively participate in team meetings, PCMH meetings as needed, or external meetings as assigned.
• Provides orientation to all CAHN employees regarding scope of practice.
• Must be able to demonstrate knowledge of ambulatory disease state management practices and pathways, medical terminology, current payer contracts, HEDIS criteria, CAHN policies and procedures, and regulatory standards of care.
• Must possess and demonstrate intermediate computer skills and establish and maintain excellent rapport with physicians, mid-level providers, and other members of the healthcare team.
• Assist with routing intra-office as well as external fax reports.
• Maintains and ensures confidentiality per HIPAA and agency guidelines.
• Other duties as assigned.

Qualifications and Desirable Traits

• Bilingual a plus.
• Certified Pharmacy Technician, Associates, Bachelor’s or Medical degree in related field or have at least 3 solid years of related experience.
• Must have BLS/Healthcare Provider CPR certification and must maintain updated certifications and/or licensures.
• Self starter, efficient, and professional and promotes the organization through positive public relations.
• Excellent interpersonal, analytical, communication skills.
• Must be computer literate with ability to demonstrate typing speed of at least 50wpm.
• Demonstrates knowledge of various prescription/insurance plans, area hospitals, physicians and medical referral policies.
• Team player, goal oriented and highly adaptable.
• Ability to work in a fast paced, multicultural environment.
• Embrace challenges and provides solutions.
• High level of punctuality and organization; must be customer service oriented.

DISCLAIMER

The above duties and responsibilities are essential job functions, subject to reasonable accommodations. All job requirements listed indicate the minimum level of knowledge, skills and/or abilities deemed necessary to perform the job proficiently.

This job description is not intended to be construed as an exhaustive statement of duties, responsibilities, or requirements. Employees may be required to perform any other job-related instructions, as requested by their supervisor, subject to reasonable accommodation.