Family Nurse Partnership (RN)

TCH Medical Center; Houston (TX); On-site; USD 60,000 - 75,000; Full time

Job summary

TCH Medical Center is seeking a Nurse Home Visitor to support the Nurse Family Partnership in the Northwest Harris County area, focusing on assisting mothers from pregnancy to parenting with health, psychosocial wellbeing, and self-sufficiency goals.

The role involves in-person home-based case management, coordinating and monitoring care to achieve optimal outcomes, and ensuring quality, service, and cost effectiveness for Health Plan members.

Qualifications

• Bachelor’s degree in nursing required.
• RN license in Texas or Nursing Licensure Compact required.
• BLS certification required.
• Minimum 3 years clinical or public health experience, preferably in Maternal-Child Nursing or related fields.
• Bilingual English/Spanish preferred.

Responsibilities

• Assesses and develops a comprehensive care plan for each mother/family.
• Coordinates services across the care continuum to meet needs.
• Documents plans and progress in designated systems.
• Advocates for members and families across care settings.
• Identifies barriers and opportunities for intervention with the team.
• Performs ongoing communication and care coordination activities.
• Participates in professional development and outcome reporting.

Skills

Bilingual English/Spanish

Driver's license

3+ years experience

Women’s services background

Education

Bachelor's degree in nursing

RN license in Texas or Nursing Licensure Compact

BLS certification

Job description

We’re looking for a Nurse Home Visitor for our Nurse Family Partnership. In this position, you will assess, plan, implement, monitor and evaluate the options and services required to meet the mother and baby's needs related to health, psychosocial well‑being, and economic self‑sufficiency. Nurse will provide comprehensive ongoing in person case management services to Health Plan members by coordinating and managing care of high‑risk members to meet multiple service needs across the continuum of care, ensure optimal member outcomes that address quality, service, customer satisfaction and cost effectiveness.

Nurse will primarily service the Northwest Harris County (I.E. Jersey Village, Cypress, Spring - but not limited)

Think you’ve got what it takes?

• Ability to assist the member/member's family in coping with the transition from pregnancy to motherhood and parenting by optimizing the member's/family's self-care abilities and supporting their consumer rights.
• Means and ability to drive an assess patients in their homes.
• Women’s services background
• Bilingual English/Spanish- highly preferred

Skills & Requirements:

• Required bachelor’s degree in nursing.
• Required Licenses/Certifications RN - Lic-Registered Nurses Texas Board of Nursing or Nursing Licensure Compact
• DL ANY - DRIVER'S LICENSE ANY STATE INSURANCE - Auto Insurance Current automobile insurance
• BLS - Cert-Basic Life Support American Heart Association
• Current personal motor vehicle insurance
• Required 3 years clinical or public health experience, preferably in Maternal-Child Nursing, Pediatrics, Mental Health, Community Health

As part of our commitment to maintaining a safe and healthy workplace, all successful candidates will be required to undergo respiratory fit testing in compliance with occupational health and safety standards.

Job Duties & Responsibilities:

• Assesses, develops, implements, and monitors a comprehensive care plan including goal setting with the team and member/family in internal and external settings.
• Proactively identifies first time mothers /members in need of case management through state reports, internal reports, community referrals and other internal referrals.
• Comprehensively assesses members (and the members child’s) medical, behavioral, and non-medical drivers of health needs and benefit eligibility.
• Participates in planning and coordinating services across the continuum of care and documents this plan in designated systems.
• Ensures for the provision of continuity of care needs as required and serves as advocate on behalf of members and families on an ongoing basis across the continuum of care.
• Collaboratively identifies problems/barriers/opportunities for intervention.
• Facilitates goal setting, resolution, and revision of plans on an ongoing basis.
• Routinely assesses members status and progress; if progress is static or regressive, determine the reason and proactively encourage appropriate adjustments in the care plan, providers and/or services to promote better outcomes.
• Performs all necessary communication and documentation functions.
• Collaborates with community health education/outreach organizations and providers to provide for the overall health promotion of members.
• Participates in professional development activities.
• Prepares and monitors outcome data to assist in identification of improvement activities/opportunities.