Team Nurse - Beth Israel Lahey Health : Job Details

1. Coordinate and facilitate quality clinical management of a broad based outpatient population across the continuum of care. Collaborates with providers to identify needs for preventive care, evidence-based chronic disease management and care coordination. Provides general and specific healthcare education. Works directly with patients to identify and monitor self-management goals. (essential)2. Collaborates care with community based providers. Follows up on ED visits and inpatient discharges. Assists providers with exams, treatments and procedures as needed. (essential)3. Provides skilled telephonic triage and assessment, education, collaboration and coordination of healthcare and community resources. Performs a direct patient care role. Nursing visits include : Annual Wellness Visits (AW - Vs) and Chronic Care Management (CCM) of our BIDHC patients. (essential)4. Responsible for INR management and teaching for those patients on Coumadin using a standardized protocol. (essential)5. A...Nurse, Patient Care, Operations, Management, Healthcare, Customer Service