Job Description
Role Description The Heart Failure Remote Patient Monitoring Registered Nurse is a remote patient monitoring RN responsible for coordination with patients via computer to monitor daily responses from Heart Failure home monitoring input devices. • Collaborates with providers and clinic staff to identify and prioritize patients appropriate for care coordination services, utilizing care coordination criteria. • Advances quality goals and facilitates the sharing of necessary data and information to support ongoing quality improvement. • Provides initial and ongoing comprehensive assessment, including a review of systems that establish a comprehensive plan of care. • Identifies, analyzes, and prioritizes problems and interventions and sets appropriate measurable goals. • Triages and assesses all data received from remote patient monitoring (RPM), such as vital signs, reported symptoms, and question responses. • Reviews daily responses each workday and contacts patients about worrisome responses and trends, significant changes in condition, or changes in other specific data elements received, as clinically appropriate. • Develops care coordination plan and goals mutually agreed upon by patient/family. • Utilizes motivational interviewing techniques and assists patient in meeting action-oriented goals and objectives. • Addresses Social Determinants of Health and barriers to obtaining care. • Completes protocol-based interventions as needed. • Completes Discharge Phone calls for patient population. • Participates in peer review of documentation for continuous performance improvement. • Reviews utilization and quality reports routinely, scanning for gaps in care and identifies patients needing the additional support of care management. • Tracks program performance using KPIs and adjusts strategies accordingly. • Ensures compliance with regulatory and privacy standards, including HIPAA. • Participates in regular team meetings. • Participates in departmental and organizational committees as applicable. • Participates in the orientation of new personnel. • Precepts and acts as a mentor to peers. • Promotes collaborative teamwork. • Serves as liaison between Heart Failure Clinic, provider practices, and patients to implement initiatives that improve access to care and the quality of services provided. • Meets with Clinical Manager & Navigation team on a regular basis to provide patient updates, identify issues, and develop strategies for resolution. • Performs all duties and responsibilities in accordance with basic principles and guidelines of professional nursing. • Ensures documentation meets current standards and policies. Qualifications • Service oriented, well versed in quality measures, and familiar with approaches for reviewing charts to identify and address quality measure gap closure through care coordination. Requirements • Bachelor's degree in Nursing (BSN) is required. • Master’s degree in Nursing (MSN) is preferred. • 3 years of relevant nursing experience, including a minimum of 2 years’ case management or nurse navigation experience, is required. • Registered Nurse licensure required. • Must be licensed or eligible to practice pending licensure as a Registered Nurse in the Commonwealth of Virginia and/or West Virginia (as applicable depending on geographical area) with either a: Multi-state license, under the Nurse Licensure Compact. Benefits • A Zero-Deductible Health Plan • Dental and vision insurance • Generous Paid Time Off • Tuition Assistance • Retirement Savings Match • A Robust Employee Assistance Program to help with many aspects of emotional wellbeing • Membership to Healthy U: An Incentive-Based Wellness Program • Health savings account & flexible spending account for childcare • Life insurance, short-term and long-term disability, and professional development • Discounts to on-campus dining and more