Population Health Education Nurse

Cozad Community Hospital•Cozad, NE

1d•Onsite

About The Position

The Care Management Nurse is responsible for overseeing and guiding several tasks to ensure that patients receive the best continuity of care throughout the entire Cozad Community Health System. The Population Health Education portion of the position is responsible for developing and implementing comprehensive health education programs aimed at promoting preventative care, chronic disease management, and community engagement in accordance with the philosophy, goals, and objectives of Cozad Community Health System.

Requirements

Associates or Bachelor’s Degree in Nursing from an accredited College of Nursing.
Electronic Health Records experience required.
Current Registered Nurse licensure in the State of Nebraska.
Basic Life Support (CPR)
Valid Driver’s License
Ability to operate a motor vehicle and complete errands based on business needs.

Nice To Haves

One year of full-time experience in rural healthcare preferred.

Responsibilities

Identifies, monitors, and assists in closing care gaps related to preventive screenings, chronic disease management, annual wellness visits, immunizations, and other quality measures.
Utilizes Population Health and ACO reporting tools to prioritize outreach efforts and improve quality performance metrics.
Conducts patient outreach and follow-up activities to support completion of recommended services and improve health outcomes.
Collaborates with providers, clinic staff, care teams, and community partners to coordinate services and remove barriers to care.
Supports transitions of care activities including post-discharge follow-up, medication reconciliation coordination, and referral management.
Assists in the implementation and monitoring of value-based care initiatives, quality improvement projects, and population health programs.
Partners with Population Health leadership to improve performance in organizational focus areas including chronic disease management, preventive screenings, annual wellness visits, and other quality initiatives.
Participates in multidisciplinary care management meetings to identify high-risk patients and develop strategies to improve patient outcomes and reduce avoidable utilization.
Stays informed on Population Health trends and best practices, supporting both staff and patient education in partnership with medical staff.
Assists with coordination of patient care, education and transition support in discharge coordination.
Follows all HIPAA guidelines and promotes and ensures patient safety.
Fulfills mission statement by performing job duties with a high level of customer service while contributing to a positive and professional environment.
Special projects and other duties as assigned.