KEY RESPONSIBILITIES:

• Assesses and identifies patients with complex clinical needs that require a coordinated plan of care.

• Develops case management plan that includes strategies or alternative interventions required to attain optimal patient and family specific outcomes.

• Analyzes progress on the plan of care, identifies variances, and intervenes utilizing process improvement methodologies to remove barriers and progress care.

• Integrates ethical provisions in all areas of the practice.

• Demonstrates leadership skills and acts as the key information and education resource for the interdisciplinary team as related to caring for complex needs and securing appropriate services.

• The responsibilities listed are a general overview of the position and additional duties may be assigned.

TECHNICAL CAPABILITIES:

CASE MANAGEMENT (INTERMEDIATE): - Demonstrates mastery of case management in practical applications for complex clinical care coordination. Possesses sufficient knowledge, training, and experience to be capable of successfully delivering results without requiring support and instruction from others. Able to train and educate by setting the example, giving instruction, providing leadership, and generally raising the level of performance of others while on the job.

RN ACCESS PATIENT EDUCATION (INTERMEDIATE): - Demonstrates mastery of patient education in practical applications of a complex nature. Possesses sufficient knowledge, training, and experience to be capable of successfully delivering patient and family education services without requiring support and instruction from others.

TREATMENT PLANNING (INTERMEDIATE): - Demonstrates mastery of treatment planning and possesses sufficient knowledge, training, and experience to be capable of successfully delivering treatment planning services without requiring support and instruction from others.

NURSING PATIENT ASSESSMENT & EVALUATION (INTERMEDIATE): - Demonstrates mastery of patient assessments and evaluations in practical applications of a difficult nature. Conducts primary care patient interviews and physical examinations. Conducts inquiry with a thorough series of questions when patients state an ailment or complaint in order to accurately identify and elaborate on the problem. Possesses sufficient knowledge, training, and experience to role model and coach less experienced peers.

EVIDENCE-BASED PRACTICE (INTERMEDIATE): - Demonstrates ability to integrate evidence from multiple sources and determine if a practice change should occur. Shares knowledge with peers and other clinical team members independently.

CORE ACCOUNTABILITIES:

• Organizational Impact: Independently delivers on objectives with understanding of how they impact the results of own area/team and other related teams.

• Problem Solving/ Complexity of work: Utilizes multiple sources of data to analyze and resolve complex problems; may take a new perspective on existing solution.

• Breadth of Knowledge: Has advanced knowledge within a professional area and basic knowledge across related areas.

• Team Interaction: Acts as a go-to resource for colleagues with less experience; may lead small project teams.

CORE CAPABILITIES:

SUPPORTING COLLEAGUES (P3):

• - Develops Self and Others: Invests time, energy and enthusiasm in developing self/others to help improve performance and gain knowledge in new areas.

• - Builds and Maintains Relationships: Maintains regular contact with key colleagues and stakeholders using formal and informal opportunities to expand and strengthen relationships.

• - Communicates Effectively: Recognizes group interactions and modifies one's own communication style to suit different situations and audiences.

DELIVERING EXCELLENT SERVICES (P3):

• - Serves Others with Compassion: Seeks to understand current and future needs of relevant stakeholders and customizes services to better address them.

• - Solves Complex Problems: Approaches problems from different angles; Identifies new possibilities to interpret opportunities and develop concrete solutions.

• - Offers Meaningful Advice and Support: Provides ongoing support and coaching in a constructive manner to increase employees' effectiveness.

ENSURING HIGH QUALITY (P3):

• - Performs Excellent Work: Engages regularly in formal and informal dialogue about quality; directly addresses quality issues promptly.

• - Ensures Continuous Improvement: Applies various learning experiences by looking beyond symptoms to uncover underlying causes of problems and identifies ways to resolve them.

• - Fulfills Safety and Regulatory Requirements: Understands all aspects of providing a safe environment and performs routine safety checks to prevent safety hazards from occurring.

MANAGING RESOURCES EFFECTIVELY (P3):

• - Demonstrates Accountability: Demonstrates a sense of ownership, focusing on and driving critical issues to closure.

• - Stewards Organizational Resources: Applies understanding of the departmental work to effectively manage resources for a department/area.

• - Makes Data Driven Decisions: Demonstrates strong understanding of the information or data to identify and elevate opportunities.

FOSTERING INNOVATION (P3):

• - Generates New Ideas: Proactively identifies new ideas/opportunities from multiple sources or methods to improve processes beyond conventional approaches.

• - Applies Technology: Demonstrates an enthusiasm for learning new technologies, tools, and procedures to address short-term challenges.

• - Adapts to Change: Views difficult situations and/or problems as opportunities for improvement; actively embraces change instead of emphasizing negative elements.