Something special starts here.
You can't define it, but you know it when you see it : the difference between an average life and the good life. When your cup is full - with joy, purpose and lifelong health - it shows. At LMH Health, we are all about healthy people, healthy communities and healthy futures, and that makes us your destination for an exceptional career. From flexible, work-life harmony to competitive pay and great advancement potential, find everything you're looking for at LMH Health.
You'll find everything you're looking for at LMH Health :
- Join a team that cares about the community
- Tuition reimbursement to support continuing education
- Professional development and recognition
- Excellent benefits
We're looking for you.
Job Description
JOB SUMMARY
The Population Health Nurse manages the cross-continuum of care and provides support for patients with high or rising health risk, and their families. Population Health Nurses work in tandem with primary care and other providers to engage patients, reduce health risks, ensure optimal health outcomes and achieve quality measures. Patient engagement may include an assessment of knowledge deficits related to self-care, coaching to improve disease management, connecting patients to community or other resources for identified needs, and improving each patient's quality of health and wellness. The ideal candidate will have :
Robust disease management content knowledge,Skilled in or willing to learn motivational interviewing, teach-back method and other evidence-based facilitation and teaching techniques,Strong interpersonal skills, andA passion for making a difference in the lives of patients.ESSENTIAL JOB RESPONSIBILITIES
Utilizes EHR and other Cerner programs and data sources to identify at-risk patients that will likely benefit from increased or extended care management services and to document services as providedPerforms need-based assessments to identify health-related risk factors (knowledge deficits, care gaps, others) with potential for improvementWorks with the patient to establishes goals and recommends interventions to meet those goals and reduce overall risk through improved understanding and self-care capabilities, care gap closure, community engagement and follow-up careProvides disease management and health coaching; makes appropriate referrals for community-based and LMH resources; coordinates healthcare services and assists with scheduling when needed; advocates for patients within the health system or with community agencies; and serves as a liaison between the patient, provider and other agencies.Employs care management skills and proven patient facilitation techniques (motivational interviewing, teach-back method, etc) throughout.Maintains longitudinal care plan and record of services and outcomes.Ensures CMS or other payer requirements for billing are met and documented.Works with health team to ensure gap closures are documented and reported for performance achievementMaintains a patient centric, customer-driven professional attitude.Demonstrates awareness of own values and attitudes and how they may affect information given to a client.Provides non-judgmental advice based on protocols and resources.Functions independently and demonstrates leadership in decision making, communication, and problem solving techniques to resolve clients' questions / concerns.Collaborates with Social Worker, healthcare providers and Director as needed.Maintains excellent communication skills, chronic disease knowledge base, proficiency with computer applications.Regular and reliable attendance is an essential function of this positionJOB QUALIFICATIONS
Required :
Registered Nurse with at least 5 years Medical Clinical experience in an Acute setting or Physician Practice.BSN degreePreferred :
At least 1 year chronic care management or disease management experienceOur Cultural Beliefs
People FirstIntegrity MattersBetter TogetherAt LMH Health, we value inclusion and diversity. We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity or expression, pregnancy, age, national origin, disability status, genetic information, protected veteran status, or any other characteristic protected by law.