Care Management

· High-risk patient care coordination from point of referral through delivery and postpartum period as needed.

· Manage and coordinate ongoing professional consultative relationships with referring OBGYN provider, subspeciality referrals as needed, maternity unit and Perinatal providers for continuity and open communication/feedback.

· Address medication adherence in patients not meeting outcome goals

· Empower patients and families through education and a trusting relationship to utilize healthcare resources appropriately minimizing unnecessary utilization.

· Maintain accurate follow-up, identifying with the Perinatal p patients to closely monitor and follow for proper care, communication, and management.

· Closely communicate with high-risk patients to determine their needs and well-being providing resources and follow up as appropriate, providing relationship building and trust.

· Provide complete and thorough records on incoming referrals and communicate appropriately to rooming nurses for any follow up needed when they chart prep for the following week.

· Develop and manage communication process between interdisciplinary team members, staff, and patients/families

· Educate patient/significant other on care and treatment options to enable patient led treatment decisions. Provide informational material to patients.

· Offer psychosocial/emotional support to patients and families

· Coordinate appointments /services for patients.

· Participate in weekly patient review with providers/office staff to help maintain accurate plan of care and continuity.

· Assist with incoming referrals, triaging as appropriate for appointment scheduling, along with appropriate record management and intake.

· Communicate regularly with referring physicians and their staff to provide patient updates and services as needed.

· Assist management in the quarterly Baby Buzz newsletter in writing and submission.

· Balance team and individual responsibilities; be open and objective to other’s views; give and welcome feedback; contribute to positive team goals; and put the success of the team above own interests.

· Develop and work with Quality partner on QI initiatives.

· Keep track of clinical statistics such as volume, cases, types of patients seen etc.

Key Accountability

· Be aware of what is happening in the department and organization by attending department meetings, reading emails, and regularly checking information on the Hub.

· Communicating face-to-face in the office setting, by telephone, or by e-mail.

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· Be actively involved in quality improvement projects and committee.

· Maintains clinical competency using the nursing process to provide quality care.

· Always striving to exceed patient’s expectations.

· Demonstrates the knowledge that patient and workplace safety is a priority by preventing errors, accidents and infections and reporting potential or actual concerns immediately.

· Integrates the UnityPoint Health-Des Moines nursing expectations of performance in all aspects of care delivery and professional practice.

· Assesses and collaborates with clinic leadership on strategies to achieve individual clinic level goals such as quality and efficiency.

· Communicates and coordinates with the healthcare team in the development of tools for optimal patient outcomes and reports findings.

· Utilizes critical thinking in making independent judgments related to patient care.

· Maintain the responsibility and accountability for the knowledge of conditions of assigned patient populations.

· Engage in process improvement work to ensure efficient and high-quality multidisciplinary care is provided.

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· Basic UPH Performance Criteria

· Continues professional development and involvement in professional activities that enhance nursing practice by sharing knowledge through networking and research.

· Demonstrates the UnityPoint Health Values and Standards of Behaviors as well as adheres to policies and procedures and safety guidelines.

· Demonstrates ability to meet business needs of department with regular, reliable attendance.

· Employee maintains current licenses and/or certifications required for the position.

· Practices and reflects knowledge of HIPAA, JCAHO, DNV, OSHA, CMS and other federal/state regulatory agencies guiding healthcare.

· Completes all annual education and competency requirements within the designated time frame.

· Is knowledgeable of hospital and department compliance requirements for federally funded healthcare programs (e.g. Medicare and Medicaid) regarding fraud, waste and abuse. Brings any questions or concerns regarding compliance to the immediate attention of hospital administrative staff. Takes appropriate action on concerns reported by department staff related to compliance.

· This position may be assigned a specific mission to address in an emergency situation to assist in disaster response and recovery as part of the UPHDM Hospital Emergency Incident Command System. Situations of a critical nature may require an individual to perform multiple tasks until additional support can be obtained.

· Demonstrates initiative to improve quality and customer service by striving to exceed expectations.

Minimum Requirements

Identify items that are minimally required to perform the essential functions of this position.

Preferred or Specialized

Not required to perform the essential functions of the position.

Education:

· Graduate of an accredited school of nursing

Experience:

· Minimum of one year OB experience along with at least 6 months high-risk OB patients

License(s)/Certification(s):

· A state of Iowa nursing license,

· Licenses & Certifications must be maintained.

· Must possess and maintain current Basic Life Support (BLS) and Mandatory Reporter certification or obtain certification within three (3) months from date of hire.

· Certification as a Healthcare coach within one year of hire.

· Certification in Integrated Care Management within 6 months of hire.

· Certification in case management, inpatient obstetrics or high-risk perinatal preferred.

Knowledge/Skills/Abilities:

· Must have strong organizational, time management and interpersonal skills and the ability to handle multiple priorities.

· Proficient in email communications and internet usage along with basic use of Microsoft Office.

Other:

Use of usual and customary equipment used to perform essential functions of the position.