Patient Care Coordination Manager
3 weeks ago
Job Overview
Under the supervision of the Care Management & System Navigation Manager, the Patient Care Coordination Manager operates in alignment with the professional standards and ethical guidelines set forth by the British Columbia College of Nurses and Midwives (BCCNM). This role emphasizes a client and family-centered approach to care, reflecting the core values and mission of Providence Health Care.
From the initial point of admission, this position is responsible for orchestrating and collaborating with the multidisciplinary team to ensure efficient patient care and to formulate timely and sustainable discharge strategies. The role involves conducting thorough nursing evaluations and guiding the interprofessional team on the appropriate level of care, interventions to overcome obstacles, and the resources necessary to achieve optimal patient outcomes, including securing necessary funding and service approvals.
The Patient Care Coordination Manager is accountable for the formulation and effectiveness of policies, procedures, and standards that underpin efficient care management and discharge planning. This role also includes participation in committees, task forces, ongoing education, and corporate initiatives. The application of data in practice is essential, focusing on identifying priority areas, measuring progress towards set outcomes, and using data as an educational resource to ensure that care plans and services are patient-centered, high-quality, efficient, and effective.
Qualifications and Skills
Education
Current registration as a Registered Nurse with the British Columbia College of Nurses and Midwives (BCCNM) is required. A minimum of three (3) years of recent, relevant experience, including at least one (1) year in community care and discharge planning, or an equivalent combination of education, training, and experience is essential.
Skills and Abilities
- In-depth knowledge of nursing theory and practice within a patient/family-centered care model.
- Comprehensive understanding of BCCNM standards for nursing practice.
- Extensive knowledge of evidence-based nursing practices relevant to diverse patient populations and the ability to apply this knowledge in a case management context.
- Familiarity with pathophysiology and pharmacology, with the ability to apply this knowledge to ensure safe discharge planning.
- Broad understanding of biological and pathophysiological indicators related to illness severity, enabling the application of medical appropriateness criteria for resource utilization and discharge planning.
- Knowledge of various health care disciplines and their roles in patient care.
- Ability to engage in comprehensive patient assessments, observations, and monitoring.
- Strong organizational and prioritization skills.
- Proven ability to analyze situations, resolve conflicts, and negotiate solutions promptly.
- Leadership capabilities to provide guidance and consultation.
- Ability to work independently and collaboratively within an interprofessional team.
- Excellent communication skills, both oral and written, for effective interaction with patients, families, colleagues, and external agencies.
- Proficient in using computerized client care information systems.
- Physical capability to perform the duties of the position.
Key Responsibilities
- Directs care coordination and discharge planning for assigned patients by actively collaborating with the interprofessional team to establish discharge objectives, rehabilitation needs, and available community services.
- Facilitates daily care rounds, guiding team members in developing medical and functional goals alongside a discharge plan that ensures a safe and timely transition for patients.
- Monitors patient progress, symptoms, and behavioral changes, adjusting care plans as necessary to maintain a focus on high-quality, efficient, and effective patient care.
- Develops and recommends policies and procedures to enhance care management and discharge planning.
- Collaborates with physicians, external case managers, and interprofessional team members to address patient care challenges, ensuring efficient care delivery.
- Advocates for patients' rights, promoting autonomy, respect, privacy, and access to information.
- Serves as a resource for staff, patients, and families regarding care management and discharge planning.
- Communicates with external agencies to secure funding and service approvals to facilitate smooth transitions from hospital to post-hospital settings.
- Maintains accurate patient records, documenting findings, discharge arrangements, and interactions with healthcare staff.
- Engages in the orientation and training of new team members as needed.
- Participates in ongoing professional development and contributes to committees and initiatives aimed at improving patient care and service integration.
Vaccination Requirement
In accordance with current Public Health Orders, all employees of Providence Health Care must be fully vaccinated against COVID-19. Proof of vaccination status will be required.
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