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Fraser Health

Public health authority operating hospitals

Care Management Coordinator - Emergency

Medical, Clinical & VeterinaryConfirmed live in the last 24 hours
Full-timeBurnaby, BC, CanadaIn-person

About the Job

Requirements

  • Current practicing registration as a Registered Nurse with the British Columbia College of Nurses and Midwives.
  • Three years of recent related acute care experience, including one year of experience in community care and discharge planning, or an equivalent combination of education, training, and experience.
  • Comprehensive knowledge of nursing theory and practice within a patient- and family-centered model of care.
  • Comprehensive knowledge of the British Columbia College of Nurses and Midwives Standards of Practice.
  • Broad knowledge of evidence-based nursing practice related to various patient population groups and ability to apply that knowledge to a case management process.
  • Ability to apply knowledge of pathophysiology and pharmacology to safely plan discharge.
  • Broad knowledge of illness or disease processes and potential long-term complications.
  • Broad knowledge of other health care disciplines and their roles in patient care.
  • Broad knowledge of clinical pathways, expected lengths of stay, resource utilization, and patient assessment.
  • Broad knowledge of external agencies and community resources.
  • Ability to engage in comprehensive assessment, observation, and monitoring of patients.
  • Ability to plan, organize, and prioritize work.
  • Ability to analyze situations, solve problems, deal with conflict, and negotiate resolutions in a timely manner.
  • Ability to provide leadership and consultation.
  • Ability to work independently in an organized and self-directed manner and as a member of an interprofessional team.
  • Ability to communicate effectively verbally and in writing.
  • Ability to operate related equipment, including applicable software.
  • Physical ability to perform the duties of the position.

Responsibilities

  • Coordinate care and discharge planning for patients; collaborate with the Patient Care Coordinator, physician, and interprofessional team to determine discharge goals.
  • Work closely with the home health liaison team to determine available services and prioritize discharge planning activities based on patient need and risk.
  • Lead interdisciplinary rounds by facilitating care planning with the health care team and other stakeholders. Focus team members on developing medical and functional goals and discharge plans to ensure safe, appropriate, and timely discharge.
  • Facilitate patient flow activities by identifying patients requiring specialized attention to move effectively through the system.
  • Coordinate patient transfers to an alternate level of care and act as a resource and advisor for referrals to services related to diagnoses and post-discharge care.
  • Observe, monitor, and evaluate assigned patient progress, symptoms, and behavioral changes by reviewing daily status, anticipating responses to care, and identifying problems or variances from the expected care plan; conduct comprehensive nursing assessments if required.
  • Intervene to resolve problems and remove barriers; reorganize priorities and collaborate with physicians and the interprofessional team to revise care plans as required, including involving patients and families in evaluating progress toward their goals.
  • Develop and recommend policies, procedures, and standards to support effective care management and discharge planning.
  • Consult and collaborate with physicians and other health care professionals and providers to identify and resolve patient care issues, including coordinating multidisciplinary team conferences, applying established acute care standards while allowing for individual variances, and developing partnerships with other facilities.
  • Identify and resolve potential barriers to efficient care delivery in collaboration with the Manager, Clinical Operations, Patient Care Coordinator, and interprofessional team.
  • Coordinate and lead case conferences and meetings with patients, families, and service providers to resolve patient care issues; identify concerns and discuss follow-up care.
  • Act as a patient advocate to protect and promote patients' privacy, dignity, and access to information, and to ensure patient choice and autonomy in decision-making and care planning.
  • Act as a resource to staff, patients, and families regarding care management and discharge planning; expedite additional services to support transitions from hospital to post-hospital settings in collaboration with the Home Health Liaison team.
  • Act as a resource for the interprofessional team, promote collaboration on concerns and continuity-of-care issues, and support resolution of complex discharge issues and patient care or service issues.
  • Prepare and maintain concise and accurate patient records, including findings, discharge arrangements, contacts with health care staff, and actions taken, in accordance with Fraser Health and regulatory standards.
  • Promote high standards of clinical practice and best practice by participating in revision and evaluation of clinical practice and systems; identify policies, procedures, and processes requiring review; recommend changes, including care plan standardization; and draft new or revised procedures, standards, and criteria for discussion with interprofessional team members and clinical leadership.
  • Work in collaboration with Fraser Health Professional Practice and related councils.
  • Participate in orientation of new team members by providing training and mentorship as required.
  • Participate in committees, task groups, continuing education, and projects.
  • Perform other related duties as assigned.

About the Company

Fraser Health

Public health authority operating hospitals

Fraser Health is a Canadian health authority that provides health services to about 1.8 million people in British Columbia. It operates 12 hospitals, including major trauma centers, as well as outpatient care and surgery centers, and offers services in residential care, public health, home health, and mental health. It employs more than 40,000 staff, medical staff, and volunteers who coordinate care across hospitals, clinics, and community settings to ensure patients receive the right care at the right time. Its goal is to keep communities healthy by delivering accessible, high-quality care and by creating good workplaces for its employees and volunteers.

Company size
10,001+
Company stage
Grant
Total funding
$20K
Headquarters
Surrey, Canada
Founded
2001

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