RN - ACO/POPULATION HEALTH
4 weeks ago
* Demonstrates professional and effective written and verbal communication skills.
* Proactively acts as a patient advocate.
* Recognizes, identifies and responds to opportunities for improvement.
* Demonstrates effective learning skills based on established, evidence based practice guidelines.
* Mentoring and coaching of other team members.
* Cultivates effective partnerships will all members of the patient care team.
* Delegation of appropriate work and skills in order to optimize and streamline workflows and interoffice resources.
* Provide a coordinated, strategic approach to identify new or manage an established chronically ill patient population.
* Stratify patient population according to risk to effectively and efficiently manage patients. Determine frequency of need for provider appointment and CCM encounters. Maximize use of qualified clinical staff within the care management team to provide appropriate non-face-to-face patient contact.
* Collaborate with practice leaders to implement effective internal tracking systems for patients such as patient panels, annual wellness visit scheduling, transition of care follow-up calls/timely provider visits, and CCM non-face-to-face monthly encounters.
* Ensure all required elements are documented for CCM and related AWV component billing.
* Ensure office staff has an effective internal tracking process to capture results, medication acquisition, missed appointments, and adherence to follow-up appointments.
* Develop a process to track Annual Wellness Visits (AWV) scheduling and ensure that patient records are reviewed appropriate to identify care gaps prior to visit with the provider visit. Post reminders to secure that all co- morbidities are discussed and documented during AWV.
* Participate in huddles with provider and care team. Identify scheduling opportunities, determine special needs for patients arriving that office/clinic day, identify patients who need care outside of their scheduled visit, patients overdue for AWV and those with missed appointments needing rescheduling. Ensure sharing of positive patient stories or compliments involving care team efforts.
* Provide clinical health coaching interventions to motivate patients and families toward successful self-management of chronic disease. Effectively partner with provider practice team members to mobilize needed community resources for the patient and family.
* In collaboration with the physician or qualified healthcare provider, develop a care plan based on mutual goals with the patient, family, the provider, and emergency plan, medical summary, and ongoing action plan, as appropriate. Monitor patient adherence to plan of care and progress toward goals in a timely fashion, and facilitate changes as needed.
* Facilitate patient access to appropriate medical and specialty providers as indicated by physician or qualified healthcare provider.
* Attend and participate in all Care Coordination related trainings and meetings as assigned. Participate and monitor PI metrics.
* This position will work at the Mahomet, Rantoul, and Monticello Family Practice Locations*
The Population Health Nurse will promote effective partnerships between patients, families, nurses, physicians, other qualified healthcare providers and clinical disciplines to coordinate care for patients with chronic disease and effectively manages care transitions and facilitate a shared goal model. He or she will partner with the provider care team for successful preventative care visits to reduce the severity of chronic disease and avoidable acute illness. He or she will provide effective clinical health coaching to assist patients with self-management of their chronic disease and life-style changes to mitigate health risk.
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RN - ACO/Population Health
4 weeks ago
Mahomet, IL, United States CARLE Full time*This position will work at the Mahomet, Rantoul, and Monticello Family Practice Locations* The Population Health Nurse will promote effective partnerships between patients, families, nurses, physicians, other qualified healthcare providers and clinical disciplines to coordinate care for patients with chronic disease and effectively manages care...
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RN - ACO/Population Health
2 weeks ago
Mahomet, IL, United States CARLE Full time*This position will work at the Mahomet, Rantoul, and Monticello Family Practice Locations* The Population Health Nurse will promote effective partnerships between patients, families, nurses, physicians, other qualified healthcare providers and clinical disciplines to coordinate care for patients with chronic disease and effectively manages care...
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RN - ACO/Population Health
4 weeks ago
Mahomet, United States CARLE Full time*This position will work at the Mahomet, Rantoul, and Monticello Family Practice Locations* The Population Health Nurse will promote effective partnerships between patients, families, nurses, physicians, other qualified healthcare providers and clinical disciplines to coordinate care for patients with chronic disease and effectively manages care...
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RN - ACO/Population Health
3 weeks ago
Mahomet, United States CARLE Careers Full time*This position will work at the Mahomet, Rantoul, and Monticello Family Practice Locations* The Population Health Nurse will promote effective partnerships between patients, families, nurses, physicians, other qualified healthcare providers and clinical disciplines to coordinate care for patients with chronic disease and effectively manages care...
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RN - ACO/Population Health
3 weeks ago
Mahomet, United States CARLE Careers Full time*This position will work at the Mahomet, Rantoul, and Monticello Family Practice Locations* The Population Health Nurse will promote effective partnerships between patients, families, nurses, physicians, other qualified healthcare providers and clinical disciplines to coordinate care for patients with chronic disease and effectively manages care...
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RN - ACO/Population Health
4 weeks ago
Mahomet, United States CARLE Full time*This position will work at the Mahomet, Rantoul, and Monticello Family Practice Locations* The Population Health Nurse will promote effective partnerships between patients, families, nurses, physicians, other qualified healthcare providers and clinical disciplines to coordinate care for patients with chronic disease and effectively manages care...
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RN - ACO/Population Health
3 weeks ago
Mahomet, United States CARLE Full time*This position will work at the Mahomet, Rantoul, and Monticello Family Practice Locations* The Population Health Nurse will promote effective partnerships between patients, families, nurses, physicians, other qualified healthcare providers and clinical disciplines to coordinate care for patients with chronic disease and effectively manages care...
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RN POPULATION HEALTH
3 weeks ago
Peoria, IL 61601, USA, United States OSF Healthcare Full timeOverviewPay range for this position is $29.62 - $43.07/hour. Actual pay is based on years of licensure.POSITION SUMMARY: The RN- Population Health protects, promotes, and restores health and wellness, by practicing at the highest level of licensure; collaborates with providers and multidisciplinary team members to provide care coordination across the...
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RN Population Health
21 hours ago
Peoria, IL, United States OSF Healthcare Full timeOverview Pay range for this position is $29.62 - $43.07/hour. Actual pay is based on years of licensure. POSITION SUMMARY: The RN- Population Health protects, promotes, and restores health and wellness, by practicing at the highest level of licensure; collaborates with providers and multidisciplinary team members to provide care coordination across the...
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POPULATION HEALTH COORDINATOR
7 days ago
Dorchester, Boston, MA, USA, United States CODMAN SQUARE HEALTH CENTER INC Full timeJob DetailsJob LocationCodman Square Health Center - Dorchester, MASalary Range$18.00 - $37.44 HourlyThe Population Health Coordinator (PHC) is an integral member of the Health Center's Population Health Team and supports the Health Center and its patients to achieve enhanced clinical quality outcomes through quality improvement and intradepartmental...
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Greeneville, TN 37745, USA, United States POPULATION HEALTH Full timeRN - Cert Lactation Consultant (FT) GCE - Greeneville, TN Job ID: 003XMA BALLAD CORPORATE Nursing - POPULATION HEALTH Full-time (scheduled 72 hrs or more per pay period) - DayJob Description SCOPE OF POSITIONThe RN - Certified Lactation Consultant is responsible for providing guidance for lactating clients and directs others in assisting these clients. The...
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Norton, VA 24273, USA, United States POPULATION HEALTH Full timeRN - Cert Lactation Consultant (FT) Norwise Ballad Medical Group - Norton, VA Job ID: 003XMB BALLAD CORPORATE Nursing - POPULATION HEALTH Full-time (scheduled 72 hrs or more per pay period) - DayJob Description SCOPE OF POSITIONThe RN - Certified Lactation Consultant is responsible for providing guidance for lactating clients and directs others in assisting...
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RN-CASE MANAGER
3 weeks ago
Visalia, CA 93291, USA, United States Kaweah Health Care District Full timeKaweah Health is a publicly owned, community healthcare organization that provides comprehensive health services to the greater Visalia area in central California. With more than 5,000 employees, Kaweah Health provides state-of-the-art medicine and high-quality preventive services in our acute care hospital, specialized health centers and clinics. Our...
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POPULATION HEALTH PRACTICE LIAISON
2 weeks ago
Honolulu, HI 96812, USA, United States Hawaii Pacific Health Full timeJob DescriptionHawai'i Pacific Health is a not-for-profit health care network with over 70 locations statewide including medical centers, clinics, physicians and other caregivers serving Hawai'i and the Pacific Region with high quality, compassionate care. Its four medical centers - Kapi'olani, Pali Momi, Straub and Wilcox - specialize in innovative programs...
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POPULATION HEALTH PRACTICE LIAISON
5 days ago
Honolulu, HI 96812, USA, United States Hawaii Pacific Health Full timeJob DescriptionHawai'i Pacific Health is a not-for-profit health care network with over 70 locations statewide including medical centers, clinics, physicians and other caregivers serving Hawai'i and the Pacific Region with high quality, compassionate care. Its four medical centers - Kapi'olani, Pali Momi, Straub and Wilcox - specialize in innovative programs...
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COMMUNITY HEALTH NAVIGATOR
7 days ago
Johnson City, TN, USA, United States Population Health Full timeCommunity Health Navigator (Temporary) (FT) 8a-5p Job ID: 004FP5 BALLAD CORPORATE Support Services - Population Health Temporary - DayJob Description SCOPE OF POSITIONCommunity Health Navigators will provide hands-on assistance to address identified unmet health-related social needs. Individuals will be identified within target populations and assigned to a...
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POPULATION HEALTH PRACTICE LIAISON
7 days ago
Honolulu, HI 96812, USA, United States Hawaii Pacific Health Full timeJob DescriptionHawai'i Pacific Health is a not-for-profit health care network with over 70 locations statewide including medical centers, clinics, physicians and other caregivers serving Hawai'i and the Pacific Region with high quality, compassionate care. Its four medical centers - Kapi'olani, Pali Momi, Straub and Wilcox - specialize in innovative programs...
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POPULATION HEALTH PRACTICE LIAISON
5 days ago
Honolulu, HI 96812, USA, United States Hawaii Pacific Health Full timeJob DescriptionHawai'i Pacific Health is a not-for-profit health care network with over 70 locations statewide including medical centers, clinics, physicians and other caregivers serving Hawai'i and the Pacific Region with high quality, compassionate care. Its four medical centers - Kapi'olani, Pali Momi, Straub and Wilcox - specialize in innovative programs...
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POPULATION HEALTH PRACTICE LIAISON
7 days ago
Kailua-Kona, HI 96740, USA, United States Hawaii Pacific Health Full timeJob DescriptionHawai'i Pacific Health is a not-for-profit health care network with over 70 locations statewide including medical centers, clinics, physicians and other caregivers serving Hawai'i and the Pacific Region with high quality, compassionate care. Its four medical centers - Kapi'olani, Pali Momi, Straub and Wilcox - specialize in innovative programs...
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POPULATION HEALTH PRACTICE LIAISON
5 days ago
Kailua-Kona, HI 96740, USA, United States Hawaii Pacific Health Full timeJob DescriptionHawai'i Pacific Health is a not-for-profit health care network with over 70 locations statewide including medical centers, clinics, physicians and other caregivers serving Hawai'i and the Pacific Region with high quality, compassionate care. Its four medical centers - Kapi'olani, Pali Momi, Straub and Wilcox - specialize in innovative programs...
