Population Health Nurse

5 days ago

Baltimore, United States Health Care for the Homeless Full time

* Sign on Incentive: $7,500 *

Overview

The Population Health Nurse plays a critical part in informing decision-making processes, identifying trends, and contributing to the development of effective strategies to enhance health outcomes. This position, through the collection and analysis of health data, identifies trends and risk factors, and works with a multidisciplinary team to implement targeted interventions. By focusing on the broader determinants of health, the Population Health Nurse plays an integral role in bridging the gap between individual care needs and building effective, efficient, and equitable systems. This position will supervise the Patient Navigator during some population health projects and campaigns

Key Role Responsibilities

* Responsible for analyzing and interpreting data related to population health, health disparities, social determinants of health and other factors that contribute to poor health outcomes and inequities.
* Develops and reviews registries to identify and create effective population health approaches to reduce gaps in care and work collaboratively with the care team to improve overall HCH population health.
* In collaboration with Population Health Program Manager, develops and maintain key performance indicators (KPIs) to assess program impact.
* Identifies clinical decision support tools and utilizes evidence-based best practices to design and coordinate multidisciplinary, disease-focused interventions for chronic disease management and preventive health screenings. Creates and edits documentation, including policies, procedures, workflows and clinical protocols, with the goal of clearly identifying responsibilities and functions of staff roles or care teams.
* Work to build external referral network and help to develop partnerships to expand access to care for clients.
* Conduct chart reviews to identify areas of improvement or opportunity and to reduce risks.
* Collaborate with Care Coordination staff and other value-based care delivery systems to address health-related needs.
* Collaborate with supportive services staff to address and implement social determinant of health interventions.
* Lead population health campaigns across the agency.

Key Agency Responsibilities

In addition to role responsibilities, every staff member has the following responsibilities as a part of their employment:

* Models and reinforces the core values of dignity, authenticity, hope, justice, passion and balance
* Actively participates in performance improvement and advocacy activities that support the mission
* Protects clients' personal health information by maintaining compliance with HIPAA and other relevant health care-related IT security regulations
* Performs other duties on an as-needed basis

Knowledge, Experience, and Skills

Formal Education and Training

* Possess current licensure as a registered nurse in Maryland
* BLS CPR certification
* BSN required

Experience

* Two years of experience in a community health setting
* Two years of data analysis experience in a health care setting
* Experience in quality improvement, quality assurance and risk management
* Experience working collaboratively in a multi-disciplinary clinical setting
* Experience in a community or public health setting working with the underserved is preferred
* Comfortable working with homeless and/or low-income individuals and families. Experience working with underserved or homeless populations preferred

Skills

* Strong organizational skills necessary to assure smooth operations of the medical clinic
* Strong interpersonal skills necessary to work with disadvantaged and underserved populations and to collaborate with other medical team members, other staff members, and personnel of other agencies
* Possesses the ability to make independent decisions when circumstances warrant such action
* Able to cope with interruptions, be flexible, and be a team player
* Able to work with ill, disabled, emotionally upset and sometimes hostile individuals
* Bilingual in Spanish and English preferred

Health Care for the Homeless is an equal opportunity employer and is committed to racial equity and inclusion. We make a particular effort to recruit and promote Black, Indigenous and People of Color (BIPOC) for open positions. BIPOC, LGBTQIA+ individuals, people with disabilities, and people with other marginalized identities are encouraged to apply.

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