Population Health Coach RN
Company: Catholic Health Initiatives
Location: Lincoln
Posted on: May 28, 2023
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Job Description:
Population Health Coach RN
Lincoln, Nebraska
CHI Health
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Partnering for a stronger, healthier world.
At CommonSpirit Health, we believe in the healing power of
humanity. We invite you to explore our specialty areas and pursue a
career in humankindness.
Employment Type: Full Time
Department: Population Health Management
Hours/Pay Period: 80
The posted compensation range of $26.25 - $38.07 /hour is a
reasonable estimate that extends from the lowest to the highest pay
CommonSpirit in good faith believes it might pay for this
particular job, based on the circumstances at the time of posting.
CommonSpirit may ultimately pay more or less than the posted range
as permitted by law.
Requisition ID 2023-293690 Employment Type Full Time Hours/Pay
Period 80 Shift Day Weekly Schedule Monday - Friday (8:00am -
5:00pm) Remote No Category Staff Nurse
Already a CommonSpirit Employee?
(https://www.commonspirit.careers/employee)
Job Details
Overview
CommonSpirit Health was formed by the alignment of Catholic Health
Initiatives (CHI) and Dignity Health. With more than 700 care sites
across the U.S. & from clinics and hospitals to home-based care and
virtual care services CommonSpirit is accessible to nearly one out
of every four U.S. residents. Our world needs compassion like never
before. Our communities need caring and our families need
protection. With our combined resources CommonSpirit is committed
to building healthy communities advocating for those who are poor
and vulnerable and innovating how and where healing can happen both
inside our hospitals and out in the community.
With guidance from CHI Health Partners' President, Medical
Directors, and Division Manager of Ambulatory Care Management,
works collaboratively with physicians, staff and other health care
professionals within his/her clinically integrated network (CIN),
CHI Health Partners, to maintain and improve quality and
sustainability within the CIN. Includes:
Chronic Disease Management-Educator
Practice Pattern Management-Referral Management, based on Quality
of Care, CHI Health Partners (clinically integrated network), and
patient experience.
Performance Data Interpretation-Develops and audits workflows
Evidence-Based Metric (EBM) guidelines-Implements and hardwires
different EBM guidelines in the clinic setting as well as
facilitating seamless transitions of care between clinic and
post-acute settings and between clinic and other health
professionals.
Responsibilities
Responsibilities
Care Coordination : identify and coordinate referrals to team
members via EMR, i.e. MSW, dietician, Prescription Assistance team,
and Certified Diabetic Educators.
Clinic Referrals : receive referrals from providers/staff via EMR
or face-to-face clinic settings.
Prescription Assistance and Financial Assistance Program Referrals
: identify patients in need due to no insurance or low income, and
place referral to Prescription Assistance program (RxAP) and/or
Social Work.
Care Management and Outreach to high risk patients and those with
chronic disease : lists will be sent out of patients in our
value-based contracts needing care gaps closed, i.e. annual
wellness visits, colonoscopies, mammograms, etc. and the PHC will
need to reach out to try to close these gaps. Identify
participating patients in need of disease management and
opportunities for preventative health interventions
New Diabetic Medication Starts : education on new injectable
medication and referral to Clinical Diabetes Education (CDE) for
formal DM education and continued follow up
ED and Inpatient Discharge Alerts : PHC will receive alerts via
Innovaccer platform notifying him/her that a patient attributed to
his/her clinic was discharged from the ED or Inpatient Unit. PHC
will use clinical judgment as to whether outreach is warranted
Communication/Care Coordination with hospital, SNF and other
healthcare professionals : maintain open communication with
inpatient care management staff and SNF population health coaches
to ensure a smooth transition from acute and post-acute settings to
home and timely and appropriate follow up care. Ensure care handoff
between levels of care is seamless. Collaborate with other members
of healthcare team to include, but not limited to staff from ED,
IP, SNF, HHC, palliative care, area office on aging, community
health workers, etc.
Other duties as assigned by management With guidance from CHI
Health Partners' President, Medical Directors, and Division Manager
of Ambulatory Care Management, works collaboratively with
physicians, staff and other health care professionals within
his/her clinically integrated network (CIN), CHI Health Partners,
to maintain and improve quality and sustainability within the CIN.
Includes:
Chronic Disease Management-Educator
Practice Pattern Management-Referral Management, based on Quality
of Care, CHI Health Partners (clinically integrated network), and
patient experience.
Performance Data Interpretation-Develops and audits workflows
Evidence-Based Metric (EBM) guidelines-Implements and hardwires
different EBM guidelines in the clinic setting as well as
facilitating seamless transitions of care between clinic and
post-acute settings and between clinic and other health
professionals.
Qualifications
RN plus 5 years of experience in a related field required.Bachelor
of Science or Masters of Science in Nursing preferred
A current RN license to practice in the State of Nebraska is
required. Certification as Healthcare Coach or obtained within two
years of hire.
Experience:Five years of clinical and case management/nursing
education/quality improvement experience required.
Clinic/Physician office, home care, public health and/or social
service experience preferred. Experience in patient education
preferred
Nursing excellence
starts with you.
Are you a career fit with our CommonSpirit Health culture? To
understand how we are structured, we believe in some core
philosophies with the following:
We will be stronger together, achieving excellence in all we do,
collaborating across the fields and growing our collective
knowledge.
We will let humankindness guide us as we treat every person with
holistic, personalized care for the body, mind and spirit.
We will advance the science and art of nursing as innovative
leaders who demonstrate the power of evidence-based, compassionate
care. If you believe in working together with humankindness for all
to advance the science and art of nursing - then you have found
your career fit with us!
"Our hope is that you will always feel inspired, knowing you truly
are the heart and soul of CommonSpirit."
- Kathleen D. Sanford, EVP, Chief Nursing Officer
Your Potential Career Path
This is a snapshot of your potential career path highlights the
series of job positions that help you progress towards your goals
and objectives. Ultimately, your career path depends on your career
values and personal goals.
Success Profile
What makes a successful Population Health Coach RN at CHI
Health?
Compassionate
Trustworthy
Proactive
Collaborative
Communicator
Balanced
Our Total Reward Offerings
At CommonSpirit Health, your Total Rewards package includes
compensation, benefits, retirement, wellness, leave, and other
programs. Please explore what we have to offer below.
Pay and Recognition
Balanced Life
Well-Being
Professional Growth
Financial Future
Dependent Care
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Equal Opportunity
CommonSpirit Health--- is an Equal Opportunity/Affirmative Action
employer committed to
a diverse and inclusive workforce. All qualified applicants will be
considered for
employment without regard to race, color, religion, sex, sexual
orientation, gender
identity, national origin, age, disability, marital status,
parental status,
ancestry, veteran status, genetic information, or any other
characteristic protected
by law. For more information about your EEO rights as an
applicant,
pleaseclick here.
(https://tbcdn.talentbrew.com/company/35300/img/v1_0/EEOC_KnowYourRightsEnglish.pdf)
CommonSpirit Health--- will not discharge or in any other manner
discriminate against employees or applicants because they have
inquired about, discussed, or disclosed their pay or the pay of
another employee or applicant. However, employees who have access
to the compensation information of other employees or applicants as
a part of their essential job functions cannot disclose the pay of
other employees or applicants to individuals who do not otherwise
have access to compensation information, unless the disclosure is
(a) in response to a formal complaint or charge, (b) in furtherance
of an investigation, proceeding, hearing, or action, including an
investigation conducted by the employer, or (c) consistent with the
contractor's legal duty to furnish information. 41 CFR
60-1.35(c).
External hires must pass a post-offer, pre-employment background
check/drug screen. Qualified applicants with an arrest and/or
conviction will be considered for employment in a manner consistent
with federal and state laws, as well as applicable local
ordinances, ban the box laws, including but not limited to the San
Francisco and Los Angeles Fair Chance Ordinances.
If you need a reasonable accommodation for any part of the
employment process, please contact us by telephone at (415)
438-5575 and let us know the nature of your request. We will only
respond to messages left that involve a request for a reasonable
accommodation in the application process. We will accommodate the
needs of any qualified candidate who requests a reasonable
accommodation under the Americans with Disabilities Act (ADA).
CommonSpirit Health--- participates in E-Verify.
Keywords: Catholic Health Initiatives, Lincoln , Population Health Coach RN, Healthcare , Lincoln, Nebraska
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