RN Health Coach (West Broward)

Essential Duties And Responsibilities

• Completes RN Health Coach Evaluation which includes a systematic assessment of patient’s functional, psychosocial needs, fall precautions, safety, environmental, nutritional, Medication reconciliation, Cognitive, and medical history, and Point of Care testing
• Identifies client readiness to change
• Identifies opportunities and issues related to the client’s growth
• With input from patient/care giver establish centered goals and outcomes to formulate and implement plan of care
• Evaluate effectiveness of Care Plan and make necessary adjustments
• Plan and structure the coaching interactions
• Prepares RN Health Coach and progress notes, and coordination of services on a timely basis
• Coeordinat PCP follow ups (call to help ensure they made their appointments) or set an appointment from the patient’s home
• Communicate directly with PCP and/or specialists regarding any problems, or changes in therapy and/or medications
• Provides for the emotional and physical comfort and safety of clients, taking into consideration their rights and cultural backgrounds
• Provides patient education, monitoring of health needs, and coordinating of community resources
• Notifies physician and supervisor of unusual reactions and/or changes in client’s condition
• Participates in case conferences, team meetings, staff meetings and Performance Improvement activities as assigned
• Facilitates patient empowerment and quality of life by promoting educated, independent patient choice on all aspects of care
• Helps clients achieve wellness and autonomy
• Improves beneficiary safety and satisfaction
• Show compassion and empathy and take a genuine interest in the patient and his/her well-being
• Adehere to all policies and procedures including but not limited to the HIPAA Privacy rule
• Documentation on EMR proficient and timely manner
• Prepares clients' discharge by reviewing and amplifying discharge plans; coordinating discharge and post-discharge requirements; orienting and training family members on post discharge care including providing available information on resources available to the patient
• Ensures that all coaching interactions are respectful and non-judgmental
• Participation in Genuine at Home sponsored in-service training
• Maintains professional licensure and other requirements
• Performs other duties as assigned

Knowledge, Skills And Abilities

• Documentation Skills: EMR proficiency, Analyzing Information, Critical Thinking Skills, Decision Making, Research Skills, Verbal and written communication proficiency
• People Skills: Conflict resolution, People Management, Integrity, compassion
• Bilingual: Spanish and English

Minimum Education And Experience

• Current Registered Nurse (RN) license in the State of Florida; Bachelor’s required
• 2+ years of nursing experience in case management, disease management, home or facility settings
• Experience managing adult, Medicare/Medicaid, and medically complex or high-risk patient populations
• Strong clinical assessment skills with a focus on chronic condition management and care planning
• Experience in care coordination and transitions of care, including post-discharge follow-up and readmission prevention
• Experience with patient education, health coaching, and holistic care to drive engagement and self-management
• Experience working collaboratively with interdisciplinary teams, including PCPs and specialists
• Proficient in MS Office Suite to include Word, Excel, Notes, Outlook