Population Health Nurse

Moses/Weitzman Health System • Connecticut, Connecticut • 1d ago

Job Description Summary:

Job Description:

The Population Health Nurse provides high quality comprehensive, professional nursing care to individuals throughout the lifespan. The PHN provides patients with both general and focused health education regarding preventive, chronic and episodic health care issues.

ROLE AND RESPONSIBILITIES

Outreach to patients to provide health care education during patient visits, by video and by telephone.

Follows up on emergency room visits and hospital discharges.

Accurately documents all aspects of patient care in the medical chart on a timely basis.

Completes medication reconciliation processes

Retrieves hospital discharge summaries from the appropriate portal and uploads into patient records, as needed

Addresses care gaps related to value based metrics as assigned

Other work as delegated by the Population Health Department Director or Supervisor

QUALIFICATIONS

Required Skills and Education

Registered nurse, in good standing.

A minimum of Bachelor's Degree

A minimum of 1 year experience working successfully in a healthcare environment

Ability to recognize signs of patient health distress and address appropriately

Familiarity with medication names; ability to read prescriber's directions for use

Comfortable using a variety of technology resources; ability to concurrently listen while typing quickly and accurately into patient record in a clear and concise manner

Possesses sound organizational skills and accuracy at all levels of job

Proven excellent communication and customer service skills

Preferred Skills

Current Connecticut RN license

Bachelor's Degree in Nursing (BSN) preferred

Fluent in both English and Spanish with ability to pass fluency exams

1+ year of experience as a nurse in ambulatory care, preferred. Experienced nurses from other settings with a strong interest in chronic disease management and primary care nursing are encouraged to apply

Commitment to care of underserved populations

Excellent written and oral communication skills

Comfort using motivational interviewing techniques

Required Licenses/Certifications

Connecticut Registered Nurse License

PHYSICAL REQUIREMENTS/WORK ENVIRONMENT

Daily and continuous computer use.

Daily and frequent telephone use.

Alternating of sitting and standing as home-work environment allows

Requires manual dexterity to perform administrative tasks, minimal physical activity required

Fully Remote and therefore requires a clean/organized space that is free from distractions at home to complete work (see CHC's Remote Worker Policy for more information)

Demonstrates a HIPAA compliant work environment

Follows CHC policies around remote work space and connectivity requirements

ADDITIONAL QUALIFICIATIONS

Additional Activities and Responsibilities:

Participates in quality improvement projects.

Precepts others

Participates in on going nursing education activities.

Communicates client information to providers and the clinical team accurately. Accurately takes messages, and communicates on the telephone.

Communicates effectively with other administrative staff, collaborates with medical providers, nursing staff and members of leadership.

Access to clients' charts and health care information within appropriate parameters.

Maintains client confidentiality.

Possess desire to collaborate with a team in a positive manner, providing insightful and evidence-based information

This Position is available for remote work.

Organization Information:

Community Health Center, Inc. (CHC) is one of the country's most creative and dynamic providers of primary medical, dental, and behavioral health services, and a leader in practice-based research, health professionals training, and use of innovative technologies to advance health and healthcare. CHC is designated as a federally qualified health center and a patient-centered medical home by HRSA, the Joint Commission, and NCQA, respectively. We deliver more than 500,000 patient visits per year from primary care hubs and community clinics across the state of CT, all connected by technology and common standards for quality. We employ several hundred medical, dental, and behavioral health providers who are engaged in practice, teaching, and research. Our Weitzman Institute is devoted to research and practice transformation and is recognized around the country as one of the premier research institutes focused on improving health care and health outcomes for special and vulnerable populations. In addition, the organization has developed three wholly owned subsidiaries from the original pilot developments within the Weitzman Institute: the National Nurse Practitioner Residency and Fellowship Training Consortium (NNPRFTC), the National Institute for Medical Assistant Advancement and ConferMed.

Time Type:

Part time

MWHS provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any @type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

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