Population Health Nurse

Quad/Graphics   •  

Gautier, MS

5 - 7 years

Posted 239 days ago

This job is no longer available.

GENERAL PURPOSE OF JOBThe Population Health Nurse will assist in the day to day operations, oversight and execution of tasks related to all clinical outreach functions, disease management, case management, referral, and population health programming for clients of QuadMed. This role is responsible for working closely with the Clinic Staff, Clinical Quality, and Operations to enhance clinical quality outcomes on an individual patient level, and assist patients throughout the continuum of care. This position will assist the Medical Director, clinic providers and staff adopt and adhere to evidence-based patient care guidelines thus increasing the delivery rates of preventive services and efficient disease management. This position will work toward improving relationships and communication between patients, providers, staff, and community. This position is responsible for analyzing data for the purposes of identifying gaps in care and proactively managing chronic conditions for the patients we serve. This role will also work closely with other Wellness / Population Health colleagues to engage participants and their families for the purpose of inspiring health literacy, sustained program engagement and the associated behavior change while promoting QuadMed Population Health Services.The Population Health Nurse focus is on supporting both the clinical care team and population health services team in improving health outcomes across the population we serve.  This position will work closely with the QuadMed health and wellness center providers, medical assistants, and other QuadMed wellness services providers (i.e. CDE, RDN) on a daily basis, as well as, utilizing population health management tools and clinical disease guidelines for outreach, care gap analysis, and medical record maintenance.  In additional to the core job duties, the Population Health Nurse will support the wellness team in developing and implementing health educational training and learning activities aligned with the unique clinic patient population, support benefit and health fairs, and support and promote personal health risk telephonic coaching, online coaching, and biometric screening events. This role is collaborative and will work cross functionally with Marketing, Quality, Operations, Business Technology, and HR teams to deliver a successful client and patient experience. KEY RESPONSIBILITIESJOB REQUIREMENTSAppropriate education and/or experience may be substituted on an equivalent basisEducation:  Requires a bachelor’s degree in nursing from an accredited college or universityExperience:

  • Five to Seven years of experience working in a clinical setting and familiarity with an electronic medical records system.
  • A minimum of two years of experience in care coordination, referral coordination, and/or population health management
  • Bilingual (Spanish) preferred
  • Chronic Case Management experiencepreferred
  • Proficiency in working with electronic medical records, preferably experience in working with population health management programs such as disease registries
  • Excellent communication skills and ability to work collaboratively with members of a clinical team
  • Ability to manage multiple tasks and organize time efficiently

Certificates, Licenses, Registrations: 

  • Requires a current, valid nursing license in the state of the position or compact state license required
  • PALS preferred
  • Requires current BLS Certification

Knowledge, Skills & Abilities: 

  • Must have strong nursing and interpersonal skills, especially in working with diverse populations. Ability to have crucial conversations with patients while using a therapeutic approach to help change behaviors and lifestyles over time is essential. Must have strong communication (verbal and written) skills.
  • In conjunction with clinic supervisor, delegate responsibilities to clinic staff (contact patient for follow-up, contact pharmacy to inquire about medication compliance, etc.)
  • Make recommendations to providers about care plan and promote additional services available to patients
  • Requires effective interpersonal and communication skills
  • Project Management / Organization Skills required
  • Strong program planning and marketing skills
  • One on One coaching/education preferred
  • Ability to engage and motivate groups and individuals