The Stroke Neurology Care Coordinator RN is responsible for development of a coordinated plan of care to promote a smooth transition for stroke patients and their families across the healthcare continuum. This individual serves as a liaison between stroke patients and their healthcare team to ensure a safe, effective, efficient and patient centered transition between the inpatient and outpatient settings. This includes but is not limited to: supporting patients through patient education, coordination of care across specialties and locations, including virtual healthcare visits. The Care Coordinator RN works to maximize patient health outcomes by identifying patient needs and proactively managing care issues to prevent unnecessary hospital admissions, readmissions and emergency room visits.
This position requires remote work. In addition to adhering to all Fairview policies, guidelines, procedures, the Fairview Commitments, and the Code of Conduct, it is the expectation the following requirements of the remote work policy will be met, including but not limited to:
Remote workspace that is clean, safe,andprofessional.
Maintains an internet connection consistent with Fairview standards at remote workspace.
Remain productive and responsive during their scheduled work hours.
Attend primary Fairview location, as needed.
Coordinates care across the M Health Fairview health care continuum for the stroke population.
Serves as single point of contact for stroke patients and their families.
Facilitates and oversees transitions within and between care settings, providers, and services.
Provides proactive disease management using evidenced based practices.
Completes post discharge 90 day functional assessment for patients who have undergone thrombolysis or endovascular treatment for acute ischemic stroke.
Coordinates and provides patient/family education that is shared and documented regarding specific diagnosis, treatments medication management, plan of care and transitions of care.
Completes pre-visit planning and post visit wrap-up and determines necessary follow-up appointments and/or treatments to optimize patient visit.
Works to maintain primary care and referring physician involvement through ongoing communication.
Organization Expectations, as applicable:
Demonstrates ability to provide care or service adjusting approaches to reflect developmental level and cultural differences of population served
Partners with patient care giver in care/decision making.
Communicates in a respective manner.
Ensures a safe, secure environment.
Individualizes plan of care to meet patient needs.
Modifies clinical interventions based on population served.
Provides patient education based on as assessment of learning needs of patient/care giver.
Fulfills all organizational requirements
Completes all required learning relevant to the role
Complies with and maintains knowledge of all relevant laws, regulation, policies, procedures and standards.
Fosters a culture of improvement, efficiency and innovative thinking.
Performs other duties as assigned
BSN OR an ADN and the completion of a BSN program within 4 years of hire
3+ years of clinical nursing experience
Current Minnesota RN-license
BLS certification or certification within orientation period
Prefer clinical nursing experience within neurosciences, with specialized knowledge of the specialty and conditions of served
Patient education and proactive disease management experience
Willingness to pursue Stroke or Neurology (SCRN or CNRN) certification within 2 years of hire
Together with the University of Minnesota and University of Minnesota Physicians we have created M Health Fairview. M Health Fairview is the newly expanded collaboration among the University of Minnesota, University of Minnesota Physicians, and Fairview Health Services. The healthcare system combines the best of academic and community medicine — expanding access to world-class, breakthrough care through our 10 hospitals and 60 clinics.Fairview Health Services (fairview.org) is an award-winning, nonprofit health system providing exceptional care across the full spectrum of health care services. Fairview is one of the most comprehensive and geographically accessible systems in the state, with 10 hospitals—including an academic medical center and long-term care hospital—serving the greater Twin Cities metro area.Its broad continuum also includes 60 primary care clinics, specialty clinics, senior living communities, retail and specialty pharmacies, pharmacy benefit management services, rehabilitation centers, counseling and home health care services, medical transportation, an integrated provider network and health insurer PreferredOne. In partnership with the University of Minnesota, ...Fairview’s 32,000 employees and 2,400 affiliated providers embrace innovation to drive a healthier future through healing, discovery and education.