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Field Nurse

2 months ago

Bloomfield, Connecticut, United States The Cigna Group Full time
Job Summary

We are seeking a skilled and compassionate Field Nurse to join our team in providing high-quality care to patients in their homes. As a Field Nurse, you will be responsible for conducting in-home visits, nursing assessments, patient triage, care coordination, and patient/family education for members assigned to our providers.

Key Responsibilities
  • Conduct in-home visits with patients enrolled in our At Home Care Chronic Risk Program and/or Advanced Care Program (ACP)
  • Provide up-to-date healthcare advice/education regarding health promotion, illness prevention, and management of disease utilizing nursing assessment data, patient, family, and approved At Home Care Triage protocol
  • Systematically assess patients' actual or potential healthcare needs, prioritize their urgency, and use creative and effective problem-solving/decision-making while recommending an appropriate disposition per clinician and protocol direction
  • Document nursing assessment, planning, implementation in the electronic health record, including presenting problem, nursing assessment interventions, education, and patients' response to interventions/treatments and education
  • Make follow-up telephone calls to patients and referrals as appropriate
  • Provide telephonic nursing assessment and triage supported by triage protocols, including timely and accurate triage documentation, escalation, and follow-up
  • Initiate medication changes and other orders, as directed by provider in response to a triage call
Health Literacy Improvement
  • Improve health literacy and coach consumers on chronic conditions, including disease process and trajectory, medication education, including possible side effects, plan of care, and individualized care goals management in a culturally sensitive and acceptable manner for the patient or caregiver
  • Identify problems or gaps in care and offer opportunities for intervention
  • Coordinate services and referrals to health programs and participate in patient education and outreach tied to HEDIS initiatives
  • Work to improve access to care and work as part of the team to manage healthcare cost and utilization
Provider Support
  • Complete telephonic nursing assessments, including social determinants of health screenings, post-hospital discharge screenings, triage, and other assessments assigned by provider
  • Assist with organizing and running a chronic care and/or interdisciplinary care team rounds where high-risk patients and care plans are identified
  • Participate in a team approach to create a care plan for the patient
  • Maintain and update spreadsheets and documents provided by health plan to prep weekly rounds of documentation
Qualifications
  • Active, unrestricted RN license in Pennsylvania
  • Ability to obtain compact license and/or additional state licensure as needed
  • 3 or more years of experience as a Registered Nurse
  • Proficient level of experience with Microsoft Office applications and strong technical aptitude
  • EMR experience and proficiency
  • BSN or ADN degree