Discharge Care Coordinator - Full Time - Continuum of Care
Alaska Native Tribal Health Consortium - Anchorage, AK

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Under general supervision of the Continuum of Care Services Director, provides professional nursing services in the ambulatory and acute care services for Alaska Native Medical Center.

Provides ambulatory and acute care services for Alaska Native and other beneficiaries. Serves as a referral center for other health care facilities throughout the State of Alaska. collects patient health data, analyze the data to determine diagnoses, identify expected outcomes individualized to the patient, develops a plan of care prescribing interventions to attain expected outcomes, implements interventions identified in the plan of care, and evaluate the patient's progress toward attainment of the outcomes.

Identifies short and long-term professional goals. Interacts with and contributes to the professional development of peers and others practicing in a Shared Governance model of nursing practice. Collaborates with the patient, family, and other health care providers in the formation of overall goals and the plan of care, as well as in decisions related to care and delivery of services.

Assists the health care team in identifying and securing appropriate services to address discharge planning needs. Systematically evaluates the quality and effectiveness of discharge planning, participating in quality of care activities to initiate positive changes in discharge planning.

Collects individual data on patients with complex discharge needs and develops data bases on populations experiencing barriers to accessing appropriate levels of care. Identifies trends and issues on current and emerging populations, high risk care needs and non acute stays in hospitals. works with Continuum of Care Services, other ANMC departments and the Regions to conceptualize and objectify issues and work toward access to appropriate levels of care.

Collaborates with the ANMC and local health care facilities to study and test solutions to access appropriate levels of care where solutions do not currently exist. Coordinates multidisciplinary patient Care Conferences for patients with score of complex discharge needs. Collaborates with ANMC teams to maintain continual improvement in flow of patients, information and materials to accomplish successful return to primary care.

Performs other duties as assigned or required.

Required Skills

Knowledge of nursing science, principles, techniques, and procedures for the care of patients.
Knowledge in patient care assessment, disease diagnosis and outcome identification.
Knowledge in patient record observations, nursing interventions, therapeutic measures and using multi -systems monitoring data.
Knowledge of healthcare terminology, anatomy, physiology and concepts of disease.
Knowledge and ability to utilize evidence based practice to develop the plan of care and interventions.
Knowledge of the hospital environment and how the services and functions interact.
Knowledge of Alaskan culture.
Skill in providing effective and compassionate nursing care, assessing patient situations and taking effective courses of action.
Skill in assessing and prioritizing multiple requests by patients, families, and team members.
Skill in providing cardiopulmonary resuscitation.
Skill in operating a personal computer utilizing a variety of software applications.

Required Experience

A Bachelor's Degree in Nursing. Must have participated in 30 hours every 2 years continuing education in nursing in general, 16 of which are in the specific area of practice. Equivalent knowledge, experience, education, or training may be substituted for education.

Specific experience may be required for each work area.

Current registered nurse license in the State of Alaska. Current BLS card. Current ACLS, PALS, NRP, TNCC, etc card as required for specific work area. Must be licensed as a RN by the State of Alaska and remain active with all annual licensing requirements.

Work involves the potential for exposure to infectious diseases. ANMC is not a latex free environment therefore some latex exposure can be expected. Some non-standard work hours are required.

National certification is preferred.

The following demands are representative of those that must be met by an employee to successfully perform the essential functions of this job. Must be able to lift up to 50 pounds. ANMC is not a latex free environment. Therefore, some latex exposure can be expected.

Provides care to the following age groups: All

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