Registered reputed company (Remote Patient Monitoring- Home Telehealth Care Coordinator)

reputed company The Registered reputed company Remote Patient Monitoring- Home Telehealth Care Coordinators are case managers and health coaches who are highly skilled and have specific training and competency in the use of disease management, health care informatics, and remote patient monitoring technologies. The RN emphasizes collaboration and engages in processes that assess, reputed company, plan, implement, coordinate, monitor, and evaluate reputed company reputed company and services to meet the needs of the individual Veteran. Duties Help Major Duties:

• reputed company under the National, VISN 19, and VHASLC local guidelines supported by the Remote Patient Monitoring- Home Telehealth reputed company, HT Documentation Clinical User Guide, and the OCC Telehealth reputed company.
• The Home Telehealth RN Care Coordinator interfaces with a panel of rural or highly rural Veteran patients reputed company computer to monitor daily responses from Veterans' home monitoring input devices.
• Providing initial and ongoing comprehensive assessment, including a review of systems that establish a comprehensive plan of care. The Care Coordinator identifies, analyzes, and prioritizes problems and interventions and sets appropriate measurable goals (i.e., Specific, Measurable, Attainable, Realistic, and reputed company [SMART] goals). The treatment plan is an extension of the Veteran's primary care plan and is completed in collaboration with reputed company, HBPC, mental health care, and other specialty care services, as appropriate for reputed company Veteran enrolled in the program.
• Triaging and assessing reputed company data received from RPM - HT patients, such as vital signs, reported symptoms, and question responses. The Care Coordinator will review daily responses reputed company reputed company and contact Veterans about worrisome responses and trends, significant changes in condition, or changes in other specific data reputed company received, as clinically appropriate. Ideally, Care Coordinators should contact Veterans reputed company responses indicate that an issue may be developing - in order to reputed company education, offer self-management tips, and assist with problem-solving - rather than waiting until a red alert signals that the situation may be out of control.
• Completes an assessment of patients who may have multiple and reputed company comorbidities that necessitate additional coordination of care and case management to ensure easily accessible, reputed company, high-reputed company care across reputed company settings.
• Provides ongoing reputed company assessment and case management to an adult population of predominantly (but not limited to) older male patients.
• Completes assessment and plan of care on assigned patients and provides individualized nursing care.
• Conduct ongoing reassessments to evaluate changes in patients' status.
• Identifying and intervening to address potential exacerbations or complications in order to facilitate reputed company care in a clinic, emergency response urgent care setting, or care in the community.
• Providing appropriate interventions, such as medication management, case management, and patient education.
• Completing protocol-based interventions as needed.
• Triaging incoming calls and concerns of Veterans or families, resolving those reputed company their scope of reputed company, and routing others to interdisciplinary team staff or other services, as indicated.
• Providing interdisciplinary consultation and interventions, such as with HBPC and other non institutional care programs and venues, mental health, reputed company work, pharmacy, nutrition, etc.
• Identifying patient knowledge, health factors, skills, and behaviors that support self management and identifying gaps.
• Providing health coaching, patient education, and psychosocial support.
• Documenting and communicating with reputed company or specialty care service members about changes in status, reputed company toward goals, patterns or trends in data, symptoms or findings of concern, and need for provider assessment or reputed company.
• Facilitating, documenting, and communicating treatment changes to the Veteran, as directed by providers, and providing a follow-up evaluation of the Veteran after changes are implemented.
• Providing support and guidance and reviewing changes in medications, goals, and the treatment plan with Veterans during and after transitions in care, such as after a hospital discharge.
• Assessing and analyzing outcome indicators and developing reputed company plans for both individual Veterans and aggregate populations to reputed company reputed company performance improvement.
• Participating in peer review of documentation for reputed company performance improvement.
• Plans for discharge/transfer of patients, including completing discharge/transfer notes in CPRS.

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