Registered Nurse (RN), Adult Health

People's Community Clinic•Austin, TX

About The Position

The Registered Nurse is an integral part of the health care team, fulfilling the Clinic’s mission by promoting and facilitating excellent health care for patients in accordance with established nursing standards. This position works as a member of a care team to coordinate patient care and support patients and families in self-management, self-efficacy and behavior change. Care team members are expected to assess and manage the health needs of the patient population and to communicate effectively with all patients, especially vulnerable populations

Requirements

Graduate of an accredited school of nursing (RN).
Two to three years of related nursing experience or training, preferably in case/care management, home health, or primary care settings
RN - Registered Nurse - State Licensure and/or Compact State Licensure Unrestricted Registered Nurse License in the State of Texas upon hire.
Basic Life Support (BLS)- obtained through approved American Heart Association
Strong patient assessment, evaluation, and triage skills.
Proficiency in maintaining accurate and thorough medical records.
Solid understanding of patient education principles and managed care models.
Ability to apply high standards of professionalism in all interactions.
Strong problem-solving skills and the ability to implement effective solutions.
Excellent organizational skills with the ability to prioritize and manage multiple tasks in a dynamic environment.
Demonstrated ability to build positive relationships with diverse patients, families, and colleagues.
Ability to work independently and as part of a team to enhance clinic efficiency and patient outcomes.

Nice To Haves

Experience with Epic EHR, preferred.
Bilingual English/Spanish preferred.

Responsibilities

Collaborate with provider to coordinate comprehensive patient care for high-risk populations.
Conduct thorough nursing assessments, including physical, social, and emotional needs, to inform individualized care plans and interventions.
Conduct regular, proactive, monthly check-ins with patients on care management (via phone/telehealth) to monitor health, set goals, and provide education.
Educate patients and families on diagnoses, treatments, medications, procedures, and self-management strategies to promote understanding, including, managing conditions and navigating complex medical systems as indicated by nurse assessment or provider direction.
Conduct coordination with community service organizations and make and/or specialist appointments and schedule other tests, treatments or procedures as needed
Perform transition of care outreach, including post-hospital discharge assessments and follow-up to support safe transition to primary care.
Triage patient needs via telephone, walk-ins, and MyChart advice requests using evidence-based standards and protocols.
Manage the provider in-basket efficiently, including timely response to patient messages, MyChart advice requests, and care coordination tasks.
Provide clinical advice to patients per plan of care (POC), provider orders, or established protocols, ensuring safe and evidence-based recommendations.
Serve as an advocate for patients and families, providing guidance, support, and resources to empower informed decision-making.
Enhance the patient experience by practicing the AIDET model.
Collaborate with the care team to identify, prioritize, and address patient and family needs in the development and implementation of care plans.
Ensure compliance with HIPAA, state board of nursing regulations, the Nurse Practice Act, and all operational and pharmacy requirements.
Perform other clinical duties as assigned, within scope of practice and validated competencies.