The Population Health Nurse (PHN) is responsible for following high-risk participating patients/beneficiaries across the continuum of health care using an evidence-based care coordination approach to provide services designed to streamline plans of care and interrupt patterns of frequent acute care hospital or emergency department use. The PHN collaborates with the PCP and other members of the health care team in the implementation of care with an emphasis on increasing the patients and caregive... more details
RN, Population Health, Full Time Days
POSITION SUMMARY:
The Population Health Nurse (PHN) is responsible for following high-risk participating patients/beneficiaries across the continuum of health care using an evidence-based care coordination approach to provide services designed to streamline plans of care and interrupt patterns of frequent acute care hospital or emergency department use. The PHN collaborates with the PCP and other members of the health care team in the implementation of care with an emphasis on increasing the patients and caregivers ability to manage their care. The PHN collaborates with the PCP and other members of the health care team in providing direction to enhance the effectiveness of the health care team including transitions across physical settings (acute to home or lower level of care setting) and transitions in health status are monitored and managed to improve patient care and outcomes (quality and finance). The PHN collaborates with IS and other departments to develop clinical information systems for: evidence-based assessment tools, intervention protocols, documentation, tracking patient visits, data collection and reporting. The PHN is responsible for the overall planning, coordinating, implementing, and evaluating the delivery of health care services and transitional care processes in accordance with Federal and State regulatory requirements and health system philosophy, policies, and procedures.
EDUCATION:
Bachelors of Nursing required. NJ RN License BLS-American Heart Association
SPECIAL SKILLS:
Highly-developed interpersonal skills, including motivational interviewing skills, to interact effectively and motivate patients to change behavior when necessary. Persuasive interpersonal skills required Demonstrated ability to influence others while motivating them to change. Reasoning and problem solving ability. Multitasking and prioritization working in a high-volume environment with little supervision. Working independently as well as in a team environment. Function within the standards of practice for case management. Exercise sound judgment. Take initiative in finding solutions to difficult and/or sensitive problems. Interpret clinical reports. Assess patient needs and develop a plan of action to address needs in collaboration with the Primary Care Physician. Function in matrix environment. Ability to apply an understanding of business fundamentals and administrative expense management of day-to-day decision-making. Strong analytical skills.
Area of Talent: Nursing
Organization: Valley Health System
Department: VS POPULATION HEALTH
Shift: Day
Status: Full Time (36+ hrs/week)
Schedule: 8:00 AM - 4:30 PM
req15105
United States
