Complex Care Nurse

3 weeks ago


Bozeman, United States One Health Full time

Complex Care Nurse Full Time position For all CHP region sites (Bozeman, Belgrade & Livingston) Practice integrated care nursing within a collaborative health care team POSITION SUMMARY: Provides professional level nursing service focusing on assessment and implementation of the patient’s clinical care plan in order to improve health outcomes. Functions as a member of the primary health care team under the general supervision of CHP Regional Clinic Director. The coordinator is a One Health employee with a specialized skill set or education and makes a significant contribution to the organization’s potential to achieve its mission . Under the direction of assigned One Health leadership , coordinators work with a high sense of initiative and responsibility to provid e guidance or work product in a specialty area . ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES : Reasonable accommodation may be made to enable individuals with disabilities to perform the essential job functions. Position Specific Duties and Responsibilities Provide s medical care management services in collaboration with the provider care teams, resource coordinators, clinical pharmacists, and behavioral health consultants including offering support for the medical respite program through H uman Resource Development Council and Bozeman Health. Creates individualized care plans for patients receiving care management services and shares these with the patients. Ensures patients proactively identified through medical home workflows receive care management services and documentation supports compliance requirements. Educates and counsels patients using easy to understand (health literate) language. Make s referrals to community, health and social services and provide liaison with these services as indicated . Advocates for patients while maintaining relationships with community healthcare providers. Perform laboratory tests, counsel and educate patients prior to and following physical exams and testing. Identify patients’ problems or needs, determine which ones a clinician must evaluate and refer accordingly. Maintains acceptable methods of charting and record keeping providing for consistent, organized patient care per clinic policies and procedures. In coordination with clinical care teams, promote the smooth functioning of care delivery and addition of new lines of care management services. Participate in Value Based Care delivery as it relates to care management and care transitions. Trains and supports clinic staff in offering care management, including supporting provider team panel management . Exemplifies a patient-centered care approach to each patient along each stage of the patient journey, while working as a key patient centered team member by communicating individual patient care needs to support the needs of patients served. Adheres to all One Health Policies and Procedures. Participates in performance optimization and risk management activities as required . Cooperates and abides by all elements of One Health’s Compliance Program. Provides exceptional customer service and models the mission of One Health when interacting with internal and external stakeholders promoting a positive image for the health center. Performs other duties as assigned or required with prior notification. Coordinator Duties and Responsibilities Utilizing advanced specialty knowledge and/or skills, p rovides coordination of organizational projects , programs, grants etc. F unction s in a self-directed and professional manner with both external and internal stakeholders . Facilitates maintenance of and development of initiatives within service and business line functions. Collaborates and communicates within teams and across organizational and business lines to involve appropriate stakeholders in development and maintenance of specialty area initiatives . MINIMUM JOB QUALIFICATIONS: Education /Certificates/Licenses : Required Nursing degree from an accredited nursing program Current license i n state of practice Valid driver ’s license BLS certification upon hire P referred Registered Nurse Experience: Required One (1 ) year of experience in community health or related field such as Family Medicine, Primary Care, or hospital Case Management Preferred Two years of community health and/or physician’s office experience Two years of care management experience Department Nursing Employment Type Full-Time Compensation $30.40/hr to $32.34/hr (DOE) plus $3.50 locality for Boz/Bel and $2.30 for Livingston



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