(RN) Transitional Care Nurse Coordinator - Congestive Heart Failure Clinic

Job Summary

Heart Failure Transitional Care Nurse Coordinators participate in an expanded nurse role as an integral member of the Heart Failure Team. They are at the forefront of the Heart Failure Disease Management Program and work in a collaborative environment with strong patient-centered interdisciplinary teams, focused on a patient-centered care model in a richly diverse work space.

Key Areas of Responsibility

• Independently obtains and performs assessments while safely triaging and guiding a patient’s clinical course.
• Presents patient history and clinical presentation to a Provider.
• Establishes, implements, and evaluates an individualized plan of care with timely and appropriate clinical advice and interventions.
• Performs extensive review of medications and eliminates inadvertent inconsistencies across transitions in care.
• Communicates effectively with Providers to validate and verify medications and ensure medication safety and improved effective medication reconciliation and follow-up care.
• Facilitates coordination of care across the continuum and collaborates with Advanced Practice Providers and Physicians to utilize therapy protocols.
• Participates in the overall program growth, referral base, outreach, protocol establishment and re-evaluation.
• Participates in research and present programmatic milestones and accomplishments in various venues.
• Coordinates the Heart Failure patient experience throughout the Hartford Healthcare continuum based on the individual needs of the patient.

Qualifications

• Bachelor of Science Nursing Degree required.
• Minimum Of 3 Years’ Acute Care Experience preferred.
• Minimum of 2-5 years’ heart failure experience preferred.
• Current Connecticut Registered Nurse License.
• Basic Life Support Certification by the American Heart Association.
• American Association of Heart Failure Nurses (AAHFN) Certification (or must obtain within 6 months of hire).

Knowledge, Skills And Ability Requirements

• Ability to adapt and be flexible to the needs of the Comprehensive Heart Failure Program.
• Ability to communicate clearly.
• Ability to utilize advanced critical thinking and judgment to make safe recommendations to both the patient and provider on how to improve their health condition or symptoms.
• Strong Clinical skills.
• Ability to concurrently manage multiple priorities.