Acute Population Health Nurse Specialist
4 semanas atrás
Why Choose FamilyCare Medical Group?
At FamilyCare Medical Group, we strive for excellence in healthcare delivery. Our commitment to hiring top-quality talent and creating a positive work environment sets us apart from other organizations. We work hard to develop an atmosphere that makes employees feel welcomed, valued, appreciated, and recognized for their contributions.
Position Summary: This position is directly involved in a collaborative process of assessment, planning, facilitation, and advocacy for options and services to meet a patient's health needs across settings that span the continuum of care. The Acute Population Health Nurse supports the team in achieving clinical standards across hospital, clinic, and community settings, coordinates resources, and provides acute and palliative nursing care.
Key Responsibilities:
• Develops and updates the individualized care plan based on a comprehensive assessment of the patient's needs.
• Engages community resources that are timely and cost-effective to obtain optimum value for the patient in support of medical and social determinants of health.
• Provides education and coaching in self-management of disease processes.
• Monitors the patient's medication adherence in conjunction with the Family Care Medical Group Pharmacist.
• Conducts ongoing communication and collaboration with the patient, family/caregiver, primary care provider, and other significant healthcare providers.
• Conducts monthly monitoring of the patient's health, safety, and functional status, and progress toward established goals.
• Conducts in-home visits to palliative care patients as needed.
Requirements:
• Registered Nurse (RN) with active New York State License – BSN preferred but experience considered in lieu of.
• 5 years minimum in nursing with 3 years case management preferred.
• Experience with geriatric population preferred.
• Strong verbal and written communication skills.
• Ability to work as part of a team.
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