RN Navigator Heart Failure, Jewish Hospital, CHF Clinic

Primary Location:

JHHS - Jewish Hospital - UMC

Address:

200 Abraham Flexner Way
Louisville, KY 40202


Shift:

Salary Shift (United States of America)

Job Description Summary:

• UofL Health is a fully integrated regional academic health system with five hospitals, four medical centers, nearly 200 physician practice locations, more than 700 providers, the Frazier Rehab Institute and Brown Cancer Center.
• With more than 12,000 team members—physicians, surgeons, nurses, pharmacists and other highly skilled health care professionals—UofL Health is focused on one mission: delivering patient-centered care to each and every patient each and every day.

Job Description:

The UofL Health - Advanced Heart Failure Therapies Program offers comprehensive care and treatment options for patients with advanced heart failure (HF), including heart transplantation and ventricular assist device (VAD). Our highly trained physicians and nurses have advanced training, specializing in advanced heart failure, complex medical needs of heart transplant, and VAD patients.

The RN Navigator is responsible for coordination of care across the spectrum of advanced heart failure with strong emphasis on patient education and engagement in care, including self-management. This employee will implement and monitor patient care plans, monitor, record and communicate patient condition, and utilize a multidisciplinary approach to patient care. This employee will note and carry out physician and nursing orders, provide efficient and effective telephone triage for the heart failure patient population and serves as the primary contact and resource for patient/family throughout the continuum of care.

They will contribute expertise as a member of a multi-disciplinary team to facilitate the provision of care of those patients with advanced heart disease and serve as a liaison between physician and other disciplines (VAD and Transplant Team) to expedite interventions which optimize clinical outcomes[

Essential Functions:

• Completes comprehensive patient health evaluations in collaboration and consultation with the Cardiologists, Specialists and Multidisciplinary Team
• Uses all components of the nursing process, to provide comprehensive nursing care, support and education to patients and their families regarding screening and diagnostic tests, and treatment of advanced heart failure
• Responsible for the coordination of care from initial referral through the care continuum including referral for advanced therapies such as mechanical circulatory support and heart transplant
• Staffs outpatient heart failure clinic, schedules follow-up visits, and triage’s patient calls.
• Provides ongoing education and reinforcement to patients and caregivers regarding medication regimen, dietary compliance, follow up, etc

Other Functions:

• Coordinates the long term follow-up care of each heart failure patient
• Schedules follow-up laboratory tests, X-rays, cardiac catheterizations, etc. according to the established protocols
• Reviews all test results and reports any abnormal findings to the appropriate physician
• Triages phone calls from heart failure patients regarding medical problems, questions/concerns, medications, etc. and provides the appropriate follow up
• Communicates with other team members regarding problems/concerns to ensure continuity of care and patient safety is maintained
• Liaises with other members of the multidisciplinary team to ensure psychosocial and financial needs of the patient are being addressed
• Maintains accurate and current documentation of demographics, To Dos, laboratory, diagnostic tests, medications, clinic visits, telephone follow up, other miscellaneous communication, etc. in the EMR

• Assures the evaluation of the CHF candidate is complete
• Initiates evaluation protocol at the time of referral including assessment of patient acuity to determine level of urgency in expediting the evaluation process.
• Obtains pertinent medical records as evidenced by information obtained in medical history interview.
• Facilitates referrals to other members of the multidisciplinary team or other care providers as indicated.
• Coordinates the scheduling of evaluation elements (labs, medical imaging, etc) for the various aspects of the evaluation/ongoing care in an efficient and cost effective manner

• Staffs the outpatient heart failure clinic.
• Schedules all clinic visits according to established protocols and the needs of the patients.
• Performs nursing assessments on each patient with documentation of findings.
• Ensures clinical assessment, plan of care, follow up plan, and vital signs are documented with each clinic visit in the EMR (Velos) including Height, Weight, Heart Rate, Blood Pressure, NYHA Class
• Assures compliance with protocols regarding medication titration, hypertension management, diuretic therapy, etc.
• Discusses findings with the heart failure physician(s) and carries out the follow-up that is indicated with changes to the plan of care
• Provides ongoing education and reinforcement to patients and caregivers regarding medication regimen, dietary compliance, follow up,
• Provides ongoing reinforcement of healthy lifestyle changes including the importance of regular health maintenance screening; drug/etoh/nicotine cessation, compliance and maintaining a healthy BMI

• Maintains compliance with all company policies, procedures and standards of conduct
• Complies with HIPAA privacy and security requirements to maintain confidentiality at all times
• Performs other duties as assigned

Additional Job Description:

• Education:
• •Associate’s Degree in in Nursing (ADN) (required)
• •Bachelor of Science in Nursing (BSN) (preferred)
• Experience:
• •Three (3) years of experience in clinical setting (required)
• •Previous patient care or health educator role in cardiology setting (preferred)
• Licensure:
• •Active Kentucky Registered Nurse License or compact license with privileges to work in Kentucky
• Certification:
• •None required
• Job Competency:
• Knowledge, Skills, and Abilities critical to this role:

• •Able to perform a comprehensive assessment of adult and geriatric patients to assess the physiological needs specific to the age of the patient served
• •Demonstrated knowledge related to age appropriate behavior of adults and geriatrics to assess the growth and development of the patient
• •Demonstrates ability to provide medical treatment based on tested knowledge of drug therapy and treatments related to the age specific requirements of adult and geriatric patients
• •Strong communication skills
• •Demonstrates exceptional customer service and interacts effectively with physicians, patients, residents, visitors, staff and the broader health care community

• Language Ability:
• •Must be able to communicate effectively in both verbal and written formats

Reasoning Ability:

• •Able to critically think through complex patient situations, process improvements, evidence-based practice
• •Able to assist others in developing clinical reasoning skills

• Computer Skills:
• •Use of electronic medical record for data review and data entry
• •Must have the capacity to learn other relevant systems and databases, as needed

• Additional Responsibilities:
• •Demonstrates a commitment to service, organization values and professionalism through appropriate conduct and demeanor at all times
• •Maintains confidentiality and protects sensitive data at all times
• •Adheres to organizational and department specific safety standards and guidelines
• •Works collaboratively and supports efforts of team members
• •Demonstrates exceptional customer service and interacts effectively with physicians, patients, residents, visitors, staff and the broader health care community

• UofL Health Core Expectation:
• At UofL Health, we expect all our employees to live the values of honesty, integrity and compassion and demonstrate these values in their interactions with others and as they deliver excellent patient care by:
• •Honoring and caring for the dignity of all persons