Population Health Nurse: Medicare Wellness & CCM Lead

Family Health Center; Vincennes (IN); In loco; USD 65.000 - 85.000; Tempo pieno

Descrizione del lavoro

Family Health Center in Vincennes, IN is seeking a Population Health Nurse to coordinate Medicare Annual Wellness Visits (MAW), Chronic Care Management (CCM), ACO initiatives, and value-based care activities. The role includes RN-led wellness visits, care planning, follow-up, and quality improvement support.

You will identify eligible patients, schedule outreach, and coordinate care transitions with providers and community resources. Epic documentation and adherence to policies are essential.

Competenze

• Graduate of an accredited RN program required.
• Current Indiana RN license required.
• BLS certification required or obtained within required timeframe.
• Experience with Medicare MAW, CCM, ACO, or value-based care preferred.
• Epic EHR experience preferred.

Mansioni

• Coordinate Medicare MAW visits, CCM, and ACO activities.
• Identify eligible patients and schedule outreach.
• Conduct RN-led wellness visits and document findings.
• Develop and manage patient-centered CCM care plans.
• Coordinate referrals and follow-up with care team and resources.
• Monitor quality measures and care coordination outcomes.
• Maintain accurate documentation in Epic per policy.

Conoscenze

RN-led patient assessment

Chronic care management

Care coordination

Critical thinking

Documentation in EHR (Epic)

Formazione

RN program graduate

Indiana RN license

BLS certification

Strumenti

Epic EHR

Descrizione del lavoro

Family Health Center in Vincennes, IN is seeking a Population Health Nurse to coordinate Medicare Annual Wellness Visits (MAW), Chronic Care Management (CCM), ACO initiatives, and value-based care activities. The role includes RN-led wellness visits, care planning, follow-up, and quality improvement support.

You will identify eligible patients, schedule outreach, and coordinate care transitions with providers and community resources. Epic documentation and adherence to policies are essential.