POPULATION HEALTH NURSE II

POSITION PURPOSE: The Population Health Nurse will be responsible for managing assigned patient populations based on chronic conditions, risk or leadership direction with the goal of achieving departmental performance goals and the appropriate population health outcomes. Provides ongoing VBS/HEDIS medical record collection and abstraction; and supports the abstraction of medical records related to VBS/HEDIS Compliance initiatives. Provides accurate assessment of provider performance against VBS/HEDIS standards and procedures.

POSITION REQUIREMENTS / QUALIFICATIONS:

Education/Experience: Graduate from an accredited college or university with a minimum of an Associate's degree in Nursing or nursing diploma. Bachelor’s degree in nursing preferred. Two (2) years’ experience in a health care or related setting. Experience in program development, project planning and implementation. Experience working with culturally diverse clients. Knowledge regarding the Joint Commission and other regulatory agencies' requirements.

Licensure / Certification: Licensed to practice as an RN (REGISTER NURSE) in the State of Florida. Maintain current CPR certification from the American Heart Association. Must have a valid Florida Driver’s License.

Skills / Ability: Excellent communication and interpersonal skills. Sensitivity in working with diverse cultural groups. Ability to present ideas and recommendations clearly and concisely in writing and orally. Excellent interpersonal communication skills: Proven ability to problem solve and solution oriented. Strong ability to work independently and as a team member with fellow co-workers, supervisors, and other staff. Demonstrates flexibility in work schedule and job assignments. General working knowledge of utilization management, performance improvement standards and procedures and NCQA Standards. Strong computer skills required.

POSITION RESPONSIBILITIES (NON-EXEMPT POSITION):

 Attends orientation sessions, scheduled meetings, and face-to-face consultation with supervisor.

 Consistently gives attention to detail.

 Coordinates home visits if warranted for non-compliant patients.

 Assist families to access the health care system and assign to a medical home.

 Communicate effectively and expresses ideas clearly; actively listen and always follow appropriate channels of communication.

 Maintains flexibility to access families during non-traditional hours.

 Collects and report results of outcomes and referrals, i.e. (A1c, Pap Smears and Preventive Oral Health Visits).

 Collects specific data as required to meet the goals of the program.

 Maintains accurate records of the activities performed.

 Follow-up and track missed appointments.

 Track coordination of referrals for outcome results.

 Provides documentation of any patient contact when abnormal results are followed-up.

 Attends scheduled in-services and training courses.

 Works to achieve patient outcome goals as established in the Section 330 Health Care Plan.

 Promptly informs supervisor of problems encountered in the line of duty.

 Follow CHI Policies and Procedures.

 Maintains and meets monthly productivity standards.

 Reports to work on time and ready to work with minimal absenteeism.

 Participate in required training.

 Adheres to Confidentiality Policies and Procedures / HIPAA Regulations.

 Treats patients with respect and dignity.

 Performs other duties as assigned.

 Medical record review, data abstraction, and quality experience.

 Schedule appointments with health care provider including appointments to PCP for their health risk assessments, preventative visits, and chronic care management.

 Ensuring accurate data entry for claim submission.

 Participate in Performance Improvement Activities.

 Ability to read and interpret medical documents.

 Strong data entry skills; capable of using a computer efficiently and effectively.

 Able to navigate and master practice management and EHR software programs.

 Ability to prioritize, multi-task, and achieve goals on time; work independently and to self-motivate.

 High production environment and, candidates must adhere to measured productivity requirements.

 Treat clients, team members and the public with courtesy, respect and present a positive public image.

 Ensuring adherence to NCQA HEDIS guidelines.

 Research medical history to determine the most appropriate and source of necessary documentation.

 Participate in appropriate continuing education in service training.

 Based on a strong knowledge of HEDIS criteria, identify the medical information that supports the specific HEDIS measure.

 Maintain current licensure and/or certificates.

 Participates in patient/community education (internal and external) and home visits when necessary.

 Perform other duties as assigned.