Community & Public Health Nursing

Hospital: Ascension St. Agnes Hospital.. Manage professional and clerical associates who work with a range of functions, including but not limited to: Access Authorization and pre-certification, utilization review and denial management, Care. The RN Manager, Post Acute Services at Ascension Saint Agnes Hospital is responsible for overseeing the integration and management of Post Acute Care, Palliative Care, and Transitional Care Management (TCM) services. At least 3 years of managerial experience in a healthcare setting, specifically with substantial exposure to post-acute care, palliative care, or transitional care. Ascension is a leading non-profit, faith-based national health system made up of over 134,000 associates and 2,600 sites of care, including more than 140 hospitals and 40 senior living communities in 19 states.

In our practice we have six family medicine providers, nine resident providers, and offer additional on sight resources for patients such as a clinical pharmacist, care manager, social worker and population health nurse.. Discounts directory with deals on the things that matter to you, like restaurants, phone plans, spas, and more!. Optional identity theft protection, home and auto insurance, pet insurance. We require a drug-free workplace and require team members to comply with the MMR, Varicella, Tdap, and Influenza vaccine requirement if in an on-site or hybrid workplace category.. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do.

Under the direction of the Population Health Management leadership, the Population Health Registered Nurse (PHRN) serves as a liaison between the Memorial Healthcare System (MHS), Memorial Health Network (MHN), Broward Guardian, ACHN, Memorial Physician Group (MPG), community providers, post-acute care facilities, external healthcare organizations, and the patient.. Performs concurrent medical record review using specific indicators and criteria established by the Population Health Nurse II. Monitors the quality, frequency and appropriateness of healthcare delivery by post-acute providers and reports variations of plan of care, health status, or psychosocial issues to PCP and appropriate members of the care team.. Discusses assessment with Population Health Nurse II for co-signature on assessment.. Follows the patient-family centered care plan developed by the Population Health Nurse II. Initiates patient conference with Population Health Nurse II for modifications to care plan.. Under the guidance of the Population Health Nurse II provides telephonic care/case management services including but not limited to health risk assessment, medication clarification, clinical-decision making, remote patient monitoring, and disease management for rising to high risk patient population.

The Community Outreach Population Health Nurse Practitioner (NP) will provide primary health care and behavioral health services as a member of a healthcare team comprised of Behavioral Health and Community Outreach RNs, Peers, Community Health Workers, and drivers. The MHC has a focus on Behavioral Health and Addiction Medicine. Able to work in a cooperative setting and interested in collaborating with a dynamic, developing behavioral health and addiction medicine team. Services provided by the MHC team include behavioral health care, preventative/primary care, vaccines, point of care testing/lab draws, and referrals. Preferred: PMHNP - Psychiatric/Mental Health Nurse Practitioner At least 1 year of experience in the field of addiction medicine preferred but not required.

The RN Navigator is a member of the patient’s care team and acts as a patient advocate providing proactive outreach to patients with chronic conditions.. Develops relationships with and facilitates referrals to community resources including Skilled Nursing, Rehab, Long Term Acute Care, Home Health, Hospice, Palliative Care, Transportation, Medication Asst., DME, and other community resources.. Performs ongoing essential Care Management activities of assessment, barrier and strengths identification, planning implementation, coordination, monitoring, and evaluation of patients.. Collaborates with team members in the discharge process, performing outreach/documentation according to CMS guidelines and the Population Health workflow.. Outreach to TOC patients should focus on medication reconciliation/adherence, self-management, use of personal health records, follow-up with PCPs/Specialists, and review of indicators that a patient’s condition is worsening and how to respond.

Able to meet the following competencies: Client/Family preparation and education, administration area safety, screening for the safe and appropriate immunization(s) to administer, preparation for the administering immunizations, maintaining correct and confidential documentation.. Complete required documentation according to the Vaccine for Children Program and CRMC/MGMC.. Collaborates with the CRMC/MGMC Community Integration Department and community partners to provide interventions to improve the health of the community.. Contacts with the community are conducted in a manner that supports the philosophy and reflects positively on CRMC/MGMC programs.. One (1) year as RN, pediatric and community health experience.

Health Advocates Network is seeking a RN - Population Health (Peds) to work at a facility in Oak Harbor , WA. This is a registry position with our company.. Coordinates the implementation of clinical practice guidelines to support AMEDD prevention and disease management-based population health initiatives through consultation and collaboration with health care providers, clinical and administrative support staff, and patients. Assists to standardize Disease Management across the patient care continuum by monitoring Disease Management of the patient in accordance with the clinical practice guidelines.. As an imbedded staff member within the PCMH practice, serves as crucial link between health care providers, members of the primary care team, and Nurse Case Managers in order to identify beneficiaries with short- and long-term health care needs. Utilizes the six core principles of population health management (i.e. identification and assessment, demand forecasting, demand management, capacity management, evidenced-based care and prevention, and program evaluation and feedback), as a framework for providing population-based health interventions to the enrolled population

Foundational to this transition is moving the business model from primarily Fee-For-Service (FFS) to FFS plus Value Based Care (VBC).. The Nurse Practitioner constructs this problem list in accordance with current standards established by CMS in its HCC-based, risk adjustment model. Educating Clinicians on How to Employ Risk Adjustment Best Practices: Meet with primary care clinicians in their offices or virtually to educate these clinicians on CMS's HCC-based, risk adjustment model.. Promoting Care Model Improvements: The Nurse Practitioner is ambassador of best practices in chronic care to community clinical teams and will have educational roles likely including, but not limited to, promotion of best practices in HEDIS measures of quality; dementia and caregiver support programs; and transitional care interventions. The allocation of time within the three above services will differ for each Population Health Nurse Practitioner based on interest, experience, and skill level of the individual as well as business needs.

Drawing on best practices in motivational interviewing and care management, the Nurse Care Coordinator collaborates with clients and multi-disciplinary teams to develop and implement flexible, patient-centered, and cost-effective strategies that support clients to achieve health-related goals. The Nurse Care Coordinator also serves as a role model and mentor to CBHC staff on best practices in care coordination, motivational interviewing and addressing social determinants of health. Assures compliance with regulatory body standards (including Joint Commission, HRSA, PCMH, and grant funding sources). Provide complex case management, including chronic disease case management, care coordination, transition care management, high risk clinical tracking, and complex medication management to appropriate patients. Facilitate disease prevention and health promotion with nursing staff, patients and families.

Coordinates the implementation of clinical practice guidelines to support AMEDD prevention and disease management-based population health initiatives through consultation and collaboration with health care providers, clinical and administrative support staff, and patients. Assists to standardize Disease Management across the patient care continuum by monitoring Disease Management of the patient in accordance with the clinical practice guidelines.. As an imbedded staff member within the PCMH practice, serves as crucial link between health care providers, members of the primary care team, and Nurse Case Managers in order to identify beneficiaries with short- and long-term health care needs. Utilizes the six core principles of population health management (i.. E. Identification and assessment, demand forecasting, demand management, capacity management, evidenced-based care and prevention, and program evaluation and feedback), as a framework for providing population-based health interventions to the enrolled population

Nirvana Healthcare is an innovative, patient-centered medical practice focused on integrative medicine, primary care, and wellness-based services.. We are seeking a Registered Nurse (RN) Case Manager to oversee patient care coordination, focusing on social determinants of health, chronic disease management, and wellness-based care.. Experience in integrative medicine, wellness-based care, or aesthetics.. Why join Nirvana Healthcare?. Innovative, patient-centered healthcare model focused on holistic wellness and preventative care.

Independence Center Licensed Practical Nurse Health Educator opportunity - Monday through Friday - 8 a.m. to 4:30 p.m. with a variety of responsibilities. Support clubhouse members through a friendly and supportive clinic environment completing physician's office support giving injections, finger stick screenings, completing vitals and documentation. Also, serve as a health educator in the health care home by reaching out in a supportive way to provide health education by encouraging positive actions by members. BJC Behavioral Health is a community health center that provides and coordinates behavioral health services for more than 8,000 seriously mentally ill adults and seriously emotionally disturbed children in St. Louis City, St. Louis County, St. François, Iron and Washington counties. As an Administrative Agent of the Missouri Department of Mental Health (DMH), BJC Behavioral Health serves as a major point of entry for people eligible for mental health services funded by DMH and is responsible for serving as gatekeeper to the public mental health system.

RN - Wellness Nurse (Population Health).. At Big Bend Regional Medical Center, our employees are the foundation of our commitment to provide compassionate care to the Big Bend region of Texas and its residents. Job Summary: Works with the providers to ensure patients are being scheduled and seen for their annual wellness visits as well as ensuring patients are being seen in office post hospital discharge.. Assists to close gaps in care and ensure patients have the resources needed at home to care for themselves.. Identifies patients who are due for exams such as screening colonoscopies, mammograms, LDCT's, lab work, etc

Join our team and be a part of something extraordinary as part of Bridgeway's Community Support Services.. As a Bridgeway Community RN you will experience the joy of helping people thrive in their community.. As part of the Community Support Services team, provides comprehensive rehabilitation needs assessment and nursing assessment, direct-support services, care management and primary health care to persons served.. Medication management to persons served and education to non-medical staff. Bridgeway Behavioral Health Services facilitates, promotes, and fosters recovery from mental illness and co-occurring problems.

Great opportunity for a RN Care Coordinator - Population Health to work in an organization that focuses on treating the whole person, physically, emotionally and spiritually. We are seeking a RN Care Coordinator - Population Health who is dedicated to providing exceptional care to those we serve at Loyola Medicine. Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.

Colton, CA – Seeking Population Health Nurse Practitioner. Vituity at Arrowhead Regional Medical Center (ARMC) is seeking an experienced and dedicated Population Health Nurse Practitioner to support our value-based care initiatives and improve health outcomes for our patients.. Promote best practices in chronic care management, including HEDIS measures and transitional care interventions.. Minimum of 2 years of experience as a Nurse Practitioner, preferably in population health, primary care, or a value-based care setting.. Arrowhead Regional Medical Center is a 456-bed university-affiliated teaching hospital licensed by the State of California Department of Public Health, operated by San Bernardino County, and governed by the Board of Supervisors.

Virginia at Home (VaH) offers home-based primary care for older adults who are homebound due to medical, functional, or cognitive issues.. Services include house calls, caregiver support, and Advance Care Planning.. Other responsibilities include traveling to patients' homes to perform frontline nursing care, when needed, including assessments, lab specimen collection, vaccine administration, and patient education.. This job description integrates the AAACN Scope and Standards of Practice for Professional Ambulatory Care Nursing, the ANA Nursing: Scope and Standards of Practice, and the ANA Code of Ethics for Nurses with Interpretive Statements, with the UVA Nursing Professional Practice Model.. The University of Virginia, i ncluding the UVA Health System which represents the UVA Medical Center, Schools of Medicine and Nursing, UVA Physicians Group and the Claude Moore Health Sciences Library, are fundamentally committed to the diversity of our faculty and staff.

Able to meet the following competencies: Client/Family preparation and education, administration area safety, screening for the safe and appropriate immunization(s) to administer, preparation for the administering immunizations, maintaining correct and confidential documentation. Complete required documentation according to the Vaccine for Children Program and CRMC/MGMC. Collaborates with the CRMC/MGMC Community Integration Department and community partners to provide interventions to improve the health of the community. Contacts with the community are conducted in a manner that supports the philosophy and reflects positively on CRMC/MGMC programs. One (1) year as RN, pediatric and community health experience.

Primary PurposeResponsible for working collaboratively with Parkland Community Health Plan’s (PCHP) Chief Medical Officer, Marketing, Provider Relations, and Quality Management to plan and implement projects and programs for health equity promotion and health disparity reduction in community.. Certification/Registration/Licensure Current and unrestricted licensure as a RN or Social Worker in the State of Texas required.. Responsibilities Strategy: This person provides subject matter expertise in equitable strategies, community health & engagement, advocacy, health equity analytics, bias reduction, and diversity equity and inclusion practices.. Oversees coordination of data collection, reporting of uniform and integrated measurement systems that support the quality assurance and performance improvement programs.. Leads and drives population health efforts and programs, clinical and continuum integration, physician performance improvement and education, and the organization strategic direction toward clinical and integration and superior value-based performance.

The Annual Wellness Visit nurse works in collaboration with the primary care provider and all members of the Population Health care team.. Primary responsibilities include identification of Medicare patients appropriate for Annual Wellness Visits (AWV) and execution guided processes to complete the AWV. May also assist clinic staff with completion of other clinical tasks as related to Population Health.. Knowledgeable of community resources and assists patients in connecting with those resources.. Serves as a patient advocate and assists in identification and improvement of service delivery.. # Must have graduated from an accredited nursing program Must have active IN RN license Must have active BLS certification Ambulatory experience required Coding and documentation experience preferred As an EOE/AA employer, Union Hospital, Inc. will not discriminate in its employment practices due to an applicant#s age, race, color, religion, sex, sexual orientation, gender identity, national origin, protected veteran or disability status.

Population Health Nurse - Dosher Memorial Clinic Network. Enroll patients in Chronic Care Management (CCM) program identified by payor or provider request. Enroll patients into Transitional Care Management (TCM) for follow-up within the clinics. Identify opportunities for gap closures based on metrics tracked through the ACO and other quality initiatives. RN, Quality Nurse, Population Health