JOB SUMMARY: Collaborates with the health care team to coordinate patient and family interventions across the continuum of care, removing barriers and promoting efficient and effective use of resources. Assists patients and families in establishing patient specific goals, both long term and short term. Facilitates appropriate follow up care and/or refers patients and provides handovers to the appropriate next level or site of care. Serves in an advocacy role on behalf of patients, families, and caregivers to ensure safe, equitable healthcare provision. Assists in developing and meeting key Pillar outcomes and system improvement goals including financial, satisfaction, and clinical as the nursing component of the care coordination model. Interacts with interdisciplinary team to conduct PDSA cycles for particular improvement efforts. Supports development of practice based on evidence and precepts colleagues accordingly. Assists in the nursing component of developing and meeting key Pillar goals including finance, satisfaction, clinical quality of care, innovation, and growth across the continuum of care.
Assesses and identifies patients with complex clinical needs that require a coordinated plan of care.
Develops case management plan that includes strategies or alternative interventions required to attain optimal patient and family specific outcomes.
Analyzes progress on the plan of care, identifies variances, and intervenes utilizing process improvement methodologies to remove barriers and progress care.
Integrates ethical provisions in all areas of the practice.
Demonstrates leadership skills and acts as the key information and education resource for the interdisciplinary team as related to caring for complex needs and securing appropriate services.
Demonstrates reflective practice by consistently evaluating case management methods and correlated outcomes.
The responsibilities listed are a general overview of the position and additional duties may be assigned.
CASE MANAGEMENT (ADVANCED): - Demonstrates the uppermost levels of expertise in applying case management in challenging and complex situations. Often takes a lead role in highly pressurized situations when there is a need to achieve results. Consistently delivers case management services in a creative and imaginative manner while setting a standard for others. Actively participates in outside professional organizations and forums. Contributes in the development of case management best practices for the organization. Often precepts colleagues.
RN ACCESS PATIENT EDUCATION (ADVANCED): - Demonstrates uppermost levels of patient education in practical applications of a complex nature. Possesses mastery of knowledge, training, and expertise to be capable of successfully delivering treatment planning services across the care continuum. Takes a lead role in complex situations when there is a need to achieve results. Actively participates in outside professional organizations and forums.
TREATMENT PLANNING (ADVANCED): - Demonstrates expert level knowledge of treatment planning and possesses mastery knowledge, training, and experience to be capable of successfully delivering treatment planning services. Considers the systemic impact of the plan of care on the organizational outcomes.
NURSING PATIENT ASSESSMENT & EVALUATION (ADVANCED): - Demonstrates the uppermost levels of expertise in patient assessment and evaluations in challenging and complex situations. Conducts primary care patient interviews and physical examination. Often takes a lead role in complex patient care situations. Possesses expert knowledge, training and experience to mentor less experienced peers.
EVIDENCE-BASED PRACTICE (ADVANCED): - Recognizes, Implements, and evaluates practice changes based on published research. Demonstrates expertise in applying evidence-based practices to challenging and complex situations.
Organizational Impact: Delivers projects/assignments that have a direct impact on goals/objectives of the unit/department that the job is in.
Problem Solving/ Complexity of work: Conducts extensive analysis of situations or data to resolve numerous, complex issues; may involve the input/work of others.
Breadth of Knowledge: Has in-depth level of knowledge within a professional area and working knowledge of other areas.
Team Interaction: May lead mid-sized projects; coaches and guides team members.
SUPPORTING COLLEAGUES (P4):
- Develops Self and Others: Invests time, energy and enthusiasm in developing self/others to help improve performance and gain knowledge in new areas.
- Builds and Maintains Relationships: Maintains regular contact with key colleagues and stakeholders using formal and informal opportunities to expand and strengthen relationships.
- Communicates Effectively: Recognizes group interactions and modifies one's own communication style to suit different situations and audiences.
DELIVERING EXCELLENT SERVICES (P4):
- Serves Others with Compassion: Seeks to understand current and future needs of relevant stakeholders and customizes services to better address them.
- Solves Complex Problems: Approaches problems from different angles; Identifies new possibilities to interpret opportunities and develop concrete solutions.
- Offers Meaningful Advice and Support: Provides ongoing support and coaching in a constructive manner to increase employees' effectiveness.
ENSURING HIGH QUALITY (P4):
- Performs Excellent Work: Engages regularly in formal and informal dialogue about quality; directly addresses quality issues promptly.
- Ensures Continuous Improvement: Applies various learning experiences by looking beyond symptoms to uncover underlying causes of problems and identifies ways to resolve them.
- Fulfills Safety and Regulatory Requirements: Understands all aspects of providing a safe environment and performs routine safety checks to prevent safety hazards from occurring.
MANAGING RESOURCES EFFECTIVELY (P4):
- Demonstrates Accountability: Demonstrates a sense of ownership, focusing on and driving critical issues to closure.
- Stewards Organizational Resources: Applies understanding of the departmental work to effectively manage resources for a department/area.
- Makes Data Driven Decisions: Demonstrates strong understanding of the information or data to identify and elevate opportunities.
FOSTERING INNOVATION (P4):
- Generates New Ideas: Proactively identifies new ideas/opportunities from multiple sources or methods to improve processes beyond conventional approaches.
- Applies Technology: Demonstrates an enthusiasm for learning new technologies, tools, and procedures to address short-term challenges.
- Adapts to Change: Views difficult situations and/or problems as opportunities for improvement; actively embraces change instead of emphasizing negative elements.
Vanderbilt University Medical Center is home to Vanderbilt University Hospital, The Monroe Carell Jr. Children’s Hospital at Vanderbilt, the Vanderbilt Psychiatric Hospital and the Vanderbilt Stallworth Rehabilitation Hospital. These hospitals experienced more than 61,000 inpatient admissions during fiscal year 2015. Vanderbilt’s adult and pediatric clinics treated nearly 2 million patients during this same period.
Vanderbilt University Hospital and the Monroe Carell Jr. Children’s Hospital at Vanderbilt are recognized again this year by U.S. News & World Report’s Best Hospitals as among the nation’s best with 18 nationally ranked specialties.
Vanderbilt University Medical Center is world renowned because of the innovation, work ethic and collegiality of its employees. From our health care advances to our compassionate care, Vanderbilt owes its accomplishments and reputation to staff and faculty who bring skill and drive and innovation to the medical center day after day. World-leading academic departments and comprehensive centers of excellence pursue scientific discoveries and transformational educational and clinical advances across the entire spectrum of health and disea...se.
As the largest employer in middle Tennessee, we welcome those who are interested in ongoing development in a caring, culturally sensitive and professional atmosphere. Most of us spend so much of our lives at work, we want to be part of maintaining a workplace in which people support one another and encourage reaching for excellence. Many high-achieving employees stay at Vanderbilt because of the professional growth they experience and because of their appreciation of Vanderbilt’s benefits, public events and discussions, athletic opportunities, beautiful setting and, above all, sense of community and purpose.
Vanderbilt and its employees share a set of mutual expectations that have been created with productivity, legality, fairness and safety always in mind. We believe that our investment in training and compensating employees multiplies in value when we enable individuals to deliver their best performance for the benefit of us all.