Heart Failure Coordinator - USFTGP Heart Failure & Mechanical Circulatory Support

Essential Functions

• Collaborates with physicians and the interdisciplinary team to implement individualized plans of care and treatment strategies for advanced heart failure patients.
• Reviews medical histories, diagnoses, treatment options, financial resources, and physician orders to ensure alignment with the plan of care and revise as needed.
• Affirms clinical stability and patient progress through clinical milestones, adjusting the care plan based on current condition and interdisciplinary input.
• Identifies barriers to care—including clinical, social, and environmental—and escalates unresolved issues through appropriate channels.
• PARTNERS WITH SOCIAL WORK AND OTHER SUPPORT SERVICES TO MANAGE COMPLEX PSYCHOSOCIAL AND MEDICAL NEEDS THAT INCREASE THE RISK OF READMISSION.
• PROVIDES HEALTH COACHING AND EDUCATION TO PROMOTE CHRONIC DISEASE SELF-MANAGEMENT, LIFESTYLE CHANGES, AND IMPROVED PATIENT ENGAGEMENT IN CARE.
• REFERS PATIENTS TO APPROPRIATE AMBULATORY, HOSPITAL, AND COMMUNITY RESOURCES TO SUPPORT COMPREHENSIVE CARE COORDINATION.
• Maintains accurate and consistent documentation of assessments, care plans, education provided, follow-up actions, and communication with physicians.
• Participates in departmental and organizational performance improvement initiatives, adhering to established procedures, protocols, and professional standards.
• SUPPORTS THE ORIENTATION AND EDUCATION OF NEW STAFF AND STUDENTS WHILE DEMONSTRATING CULTURE CARE AND SHOWTIME PRINCIPLES IN ALL CUSTOMER INTERACTIONS.

Qualifications

• Bachelor's Degree - Registered Nurse
• Active Florida Nursing License
• Three (3) years nursing experience in acute care or ambulatory setting
• Cardiology, heart failure experience - preferred