VNA Health Care - Aurora, Illinois

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Care Coordination RN - Call Center
Job Code:06162017-139
FT/PT Status:Regular Full Time

A registered professional nurse who will have primary responsibility for call center triage based activities, they will also receive cross training in 1) VNA Care Coordination Nurse – Clinic Based and 2) Care Coordination Nurse – Home Health, providing back up to other team members as needed.

Primary Functions:
  • Understands and accepts responsibility for all professional care duties performed. Follows accepted standards of nursing practice.
  • Demonstrates the ability to perform comprehensive initial and ongoing assessment/evaluation of patient and family. Provides initial health risk assessments and annual comprehensive health assessments to meet health plan requirements.  Assessment includes physical, functional, psychosocial, and environmental needs and activities of daily living. Also included is assessment for the risk of pathological grief, cultural and spiritual implications and verbal and non-verbal communication patterns.
  • Coordinates patient care and communication among VNA primary care provider, other VNA services, other specialty services, community resources and volunteer based organizations.  Communicates with these members on a regular basis for progress reports
  • Develops, evaluates, updates, and manages a nursing plan of care based on the physician’s orders, patient and nursing needs. The plan is to include nursing diagnosis, patient goals, nursing interventions, frequency of visits, and plans for discharge. Focuses care on managing discomfort, providing symptom relief and, when needed, provision of specialized palliative and end life of care. Follows plan of care and physicians orders.
  • Coordinates all patient care including but not limited to physician orders, durable medical equipment, labs, therapy, social work and clergy support.
  • Notifies physician appropriately of significant clinical changes or findings. Communicates with physician regarding changes in care when appropriate.
  • Works independently to provide competent quality nursing care to those patients whose conditions require professional nursing judgment (substantial specialized nursing skill). Requires such tasks as patient transfers (1 person), lifting patients, ambulating patients, performing ROM and positioning patients as well as nursing procedures (such as foley catheter changes, specific blood draws, IV care).
  • Handles complex case management of patients and ensures care continuity through all sites of health care services - clinic, Emergency room, inpatient and home based services.
  • Teaches self-care, mental and physical well-being and promotes independence and patient rights.  Reinforcing the importance of preventative care and appropriate use of emergency versus primary care services.
  • Evaluates the effectiveness and outcomes of care. Determines if patient goals are being met and makes changes accordingly. Communicates these changes to the patient care team.
  • Completes timely, current and accurate documentation for all patient care activities. Follows organization documentation guidelines including electronic and paper processes.
  • Follows infection control and infection prevention per protocol, demonstrating sound judgment in decision-making.


  • BSN preferred. Current Registered Nurse License in the State of Illinois under the Illinois Nursing Act.
  • Experience: Two or more years of generalized nursing experience preferred, preferably with Community Health experience.
  • Knowledge and Ability: Comprehensive knowledge and skill in current nursing practice; concept of multidisciplinary team approach to nursing care; knowledge of professional limitation and scope of practice within the Illinois Nursing Act.
  • High degree of sensitivity to the rehabilitation needs of patients and their families and the ability to establish constructive working relationships with them.
  • Maintains current CPR certification.
  • Owns and operates a car.
  • Maintains current driver's license and car insurance.
  • Computer skills required.
  • Health Policies and requirements met (See Personnel Policies).

Essential Functions/Physical Requirements:
1. Ability to perform tasks involving physical activity which includes heavy lifting and extensive bending and standing.
2. Ability to communicate effectively verbally and in writing.
3. Tactile, visual, auditory and olfactory senses intact.
4. Ability to climb stairs and ambulate in and out of patient's homes in all weather.
5. Ability to drive a car.
6. Manual dexterity sufficient to perform nursing procedures.
7. Ability to deal effectively with high levels of stress.
8. Ability to wear a particulate respirator during patient care as necessary.

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