Job Duties and Responsibilities:
•        Work as part of the clinical nursing team to provide a full range of nursing services, including patient assessment, phone advice, case management, care team coordination, provide patient education.
•        Review provider/clinician laboratory results on a daily basis, identifying and communicating common items to patients or provider per organizational protocol.
•        Review provider/clinician diagnostic imaging reports received from outside agencies and communicate to patients or provider per organizational protocol.
•        Refill medications for care team patient panels per established Nursing Protocols.
•        Monitor care team patient panels referral status, ensuring documentation is complete, patient compliance or barriers are addressed, and referral completion is documented.
•        Work to resolve telephone encounters within 72 business hours of receipt.
•        Monitor support team and nurse schedule for appropriate appointment types and cycle times.
•        Notify patients of test results and follow up plan per protocol or as directed by provider/clinician.
•        Monitor provider's schedules in the care team for available daily access for each care team provider/clinician and that each appointment is appropriate for each individual provider's scope of services.
•        Monitor population management activities by support staff, ensuring documentation is complete and interventions are identified in the patient's health record.
•        Ensure effective management of the vaccine/immunization programs.
•        Develop care plans that prevent disease exacerbation, improve outcomes, increase patient engagement in self-care, decrease risk status, and minimize unnecessary hospital inpatient and ER utilization.
•        Utilize behavioral strategies, such as motivational interviewing, to assist patients in adopting healthy behaviors, improving self-care, managing chronic disease, and utilizing in-house resource.
•        Assist patients in problem-solving issues related to the health care system, financial and psychosocial barriers.
•        Provide ongoing evaluation and documentation of patient progress/risk status and appropriate scheduling of follow-up care.
•        Communicate/affirm patient needs, plan of care, and changes in status with the patient's PCP, team, and the patient/family.
•        Manage care coordination systems for referrals, ordered test completion, and receipt of report from outside providers.
•        Supervises and supports integrative behavioral health services.
•        Participate in care team meetings to evaluate outcomes of care with the care team.
•        Provide leadership to care team support staff.
•        Model professionalism and excellent customer service standards.
•        Monitoring of Crash cart/AED.
•        Other duties as assigned.
Education/Licensing/Training:
·        High School Diploma or Equivalent.
·        Valid RN or LVN California License in good standing with the California Board of Nursing.
·        CPR Certification.
Knowledge, Skills and Experience:
·        Ability to read, write, and communicate in the English language.
·        Broad knowledge of principles and practices, care coordination or case management.
·        Must possess excellent time management, organizational, and work planning skills.
·        Knowledge of personnel management principles.
·        Knowledge of health care regulations and guidelines.
·        Demonstrated experience in a healthcare, mental health, or social work related field, or any satisfactory combination of experience and training which demonstrates the knowledge, skills and abilities to perform the above duties.
- Medical, Dental and Vision Insurance
- 401(k) with matching
- Generous Paid Time Off, Personal Day, and Holiday packages
- Flexible Spending Account Plan
- Employee Assistance Program
- Life/ADD insurance policy
- Long Term Disability Insurance
Compensation:
- Registered Nurse: $114,400.00 to $135,200.00 per year, depending on experience and credentials
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