Team Nurse

AbsoluteCare; Cleveland (OH); On-site; USD 85,000 - 95,000; Full time

Benefits offered by this job

Sign-on bonus $2,500

Job summary

AbsoluteCare is hiring aRegistered Nurse to support primary care activities for the PCP panel. You will educate patients, manage orders and referrals, and collaborate with the integrated care team to close care gaps and improve outcomes.

The role involves patient education, medication management, and proactive care coordination within a professional office setting. On-site nursing and triage duties are required.

Qualifications

• Active RN license in state of practice
• 3+ years of clinical experience with adults/geriatrics with chronic conditions
• CPR certification required
• Community-based organization experience preferred
• Proficient in clinical nursing tasks (wound care, venipuncture, phlebotomy) and chronic disease management
• Excellent communication, problem solving and organizational skills
• Independent self-starter with interest in population health and care model development
• MS Office proficiency

Responsibilities

• Support PCP in primary care activities, patient education, orders and referrals
• Manage diagnostics orders, refills, record reviews and member messages
• Lead panel management and close care gaps using reports and standing orders
• Ensure timely follow-ups and access to the PCP
• Coordinate services to complete care plan tasks
• Meet members in-center for medication reconciliation and coaching
• Engage members by phone between visits to support care plans
• Participate in daily care team huddle
• Bridge between PCP and integrated care team for referrals
• Coordinate with Immediate Care Area for triage and nursing interventions
• Provide coverage for team members including point-of-care testing and medication administration
• Prioritize care responsibilities with provider panel management

Skills

Wound care

Venipuncture

Phlebotomy

Chronic disease management

Communication

Organizational skills

Independent self-starter

Population health

Education

Registered Nurse license

CPR certification

Job description

Sign On Bonus $2,500 (Monday-Friday 8:00 AM-5:00 PM)

Salary range $85,000-$95,000

Job Summary

This role works with a dedicated Primary Care Provider and supports primary care activities for the PCP panel, including patient education, orders, referrals, and medication management, and addressing gaps in care. The Team Nurse works directly with members to achieve their care plan goals through patient education, care coordination, and building relationship.

Duties And Responsibilities

• Act as the practice-based nurse, supporting on-site providers in facilitating high quality primary care that promotes appropriate healthcare utilization.
• Facilitate Patient Centered Medical Home (PCMH) functions through management of diagnostic order tracking, medication refills, review of the medical record, and fielding messages from members and the integrated care team.
• Lead panel management for members attributed to the assigned primary care provider through activities including, but not limited to, following disease care pathways, entering standing orders for preventive care, and leveraging available reports to close care gaps.
• Monitor access to the primary care provider. Ensure members have scheduled follow-up.
• Coordinate services to complete primary care provider action plan tasks.
• Meet with members in the medical center as an extension of the primary care provider to address member needs, including medication reconciliation and teaching and coaching for effective disease management.
• Engage members telephonically between primary care visits to support PCMH activities, panel management, and action plan completion.
• Prepare for and participate in daily huddle with the integrated care team.
• Act as a bridge between the primary care provider and the greater integrated care team. Coordinate internal referrals between team members.
• Coordinate with the Immediate Care Area to provide in person and telephonic triage. Perform nursing interventions including wound care, IV (intravenous) therapy, and phlebotomy as needed.
• Provide coverage support for fellow care team members as needed, including point of care testing, medication administration, and office flow.
• Leverage strong time management skills to prioritize and balance member care responsibilities with provider panel management and role-specific tasks.

Minimum Qualifications

• Active, unrestricted license as a Registered Nurse in the state of practice required. Compact RN license preferred, or willingness to obtain.
• 3+ years of experience providing clinical services to Adult and Geriatric individuals with co-occurring chronic medical and behavioral health conditions.
• Active CPR certification.
• Experience working for a community-based organization preferred.
• Proficiency in clinical nursing skills such as wound assessment and care, venipuncture and phlebotomy, and assessment and management of common chronic conditions such as diabetes, hypertension, CHF, and COPD.
• Excellent interpersonal communication, problem solving, and organizational skills.
• Independent self-starter and critical thinker interested in population health, healthcare utilization management, and the ongoing development of our care model.
• Proficiency with Microsoft Office applications.

Working conditions

This job operates in a professional office environment. This role routinely uses general office equipment. Often wear a special uniform, such as a lab coat or surgical scrubs, protective or safety attire, such as gloves and masks. Exposed to the diseases and infections of patients daily. May share workspace with other technicians and staff.

Physical Requirements

• Ability to communicate clearly and exchange accurate information constantly.
• Ability to remain stationary for long periods of time.
• Constantly operates computer, keyboard, copy and fax machine, phone, and other general office equipment.
• Ability to occasionally move objects up to 20 lbs.