Founded in 1923, Caribou Medical Center (CMC), is a 25 bed federally certified Critical Access Hospital. Services include an Emergency Department, with 24/7 physician coverage, full radiology and clinical laboratory services, outpatient services, including wound care and chemotherapy, ICU/CCU and inpatient beds, including swing beds. CMC is located in Soda Springs, Idaho. A rural community surrounded by vast hunting, fishing, and outdoor activities.

Summary/Objective: As the Swing Bed Program Coordinator you will be responsible for designing, managing, monitoring, and evaluating all operational functions and activities of the swing bed program. The coordinator will work with a team of Case Managers, Social Service, Nurses and C.N.A.’s dedicated to building the swing bed program.

Core Responsibilities

Manage Swing Bed admissions and discharges, eliminating delay in clinical reviews and acceptance/denial of admissions to Swing Bed Program.

• Able to analyze various types of data reports for stratification of the identified population.
• Participates in and supports the development and actualization of the Department of Nursing’s goals. Assists in communicating the philosophy and expectations of the Department of Nursing.
• Participates as primary nurse for Swing bed patients as needed during times of increased census/acuity of acute care floor

Collaborate with Case Management/Patient Navigator to increase swing bed referrals/admissions.

• Coordinate the integration of post-discharge needs into patient care plans.
• Work with the appropriate agencies and makes necessary referrals to intervene for patient safety concerns.

Serve as patient, family, and facility advocate.

• Holds Patient/Family and IDT meetings regularly to meet patient needs.
• Provider patient/family education regarding chronic illness management.
• Maintains an effective working relationship with admitting providers to ensure optimal patient outcomes and coordination of care.
• Maintain knowledge of community based and county resources to promote care continuity and patient safety post discharge.

Oversees and participates in patient care planning to assure goals are appropriate and measurable.

• Intervenes and takes appropriate action in situations related to violation of hospital policy or employee injury.
• Investigates and reports quality concerns and adverse events.
• Swing Bed program management including marketing and community outreach.

Identify patient needs via direct line of communication with providers to ensure patient knowledge and understanding of post-discharge requirements and coordination.

• Serves as a liaison between the patient, family and healthcare providers.

Chronic Care Management.

• Conducts chronic condition management for individuals with target chronic conditions.
• Conducts outreach through face-to-face follow up, by telephone, secure email, or postal mail with goal of engaging enrollee.
• Assesses individual needs and develops plans to address needs/issues related to conditions(s) and/or overall health.
• Actively participates with community-based initiatives related to care management and transitions of care.
• Conducts patient education regarding condition and symptom management, red flag warning signs, the importance of adhering to medications and evidence-based guidelines and refers to customer sponsored or community support programs.
• Actively participates with ACO (Accountable Care Organization)
• Establishes self-management goal(s) with patients using self-management support concepts and m otivational interviewing techniques.

Transition Care Management.

• Carries out transitional care management program.
• Conducts follow-up calls.
• Performs service coordination.
• Ensures Care Plan development.
• Conducts patient education.

Other duties as assigned. Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for their job. Duties, responsibilities, and activities may change at any time with or without notice.

Applicant need to have one of the following qualifications:

Associate Degree (BSN Preferred).

• RN License to practice as a professional Registered Nurse in the State of Idaho or Active Multi-State RN Compact License (Employees with RN Compact Licensure are required to obtain an unencumbered Idaho RN License within 90 days of hire date

Licensed Social Worker (LSW).

BS in Social Work.