RN - Chronic Care / Health Coach

Ortonville Area Health Services • Ortonville, MN

2d

About The Position

The RN Chronic Care/Health Coach provides comprehensive nursing care and care coordination services for patients with chronic and complex health conditions. The position combines direct patient care, population health management, chronic disease registry oversight, preventive care services, and health coaching to improve patient outcomes and support quality initiatives.

The RN develops a panel of patients requiring chronic care management and provides individualized care planning, education, coaching, and follow-up. The position maintains an independent schedule of nurse visits and contributes to organizational quality improvement efforts through disease registry management and implementation of evidence-based interventions. The role is 76 hours per pay period, with one full day and one additional half day off per pay period. Scheduled hours are 7:30 a.m. to 5:00 p.m., with a 30-minute unpaid lunch.

Requirements

• At least three years of professional nursing experience in a clinical setting is preferred.
• Current Registered Nurse (RN) license in Minnesota and South Dakota.
• Strong communication, patient education, and care coordination skills.
• Ability to work independently and collaborate effectively with providers and clinic staff.
• Obtain Health Coach Certification within six months of hire.
• Maintain required continuing education and professional competencies.

Responsibilities

• Provide comprehensive nursing care and care coordination for patients with chronic and complex health conditions.
• Manage population health needs and oversee chronic disease registries.
• Provide preventive care services and health coaching.
• Develop a panel of patients requiring chronic care management.
• Provide individualized care planning, education, coaching, and follow-up.
• Maintain an independent schedule of nurse visits.
• Contribute to organizational quality improvement through disease registry management and evidence-based interventions.

What This Job Offers

• Job Type: Full-time
• Education Level: No Education Listed