Population Health Nurse Care Manager
Company: Kolmac
Location: Baltimore
Posted on: April 20, 2024
|
|
Job Description:
The Population Health Nurse Care Manager at Kolmac Integrated
Behavioral Health and all its subsidiaries ("Kolmac" or the
"Company") under general supervision oversees the implementation of
the CCG Population Health. This position is accountable for
designing and maintaining systems to ensure the continuity of care
between the OTP program and somatic and behavioral healthcare
providers both within CCG and in the community, as well as
developing processes to assist consumers in the development and
maintenance of healthy lifestyles and illness management
skills.
-Acts as a comprehensive care coordinator for participants assigned
to care, assessing their needs accordingly and facilitating
communication amongst other clinicians providing careLeads practice
transformation based on Population Health principles and
state/accrediting body requirements.With agency leadership, acts as
a "champion" for the Population Health philosophy and provides
education to staff.Develops and maintains working relationships
with primary and specialty care providers including inpatient
facilities and emergency departments.Monitors Population Health
performance at the population and participant level and implements
improvement efforts via statistical data gathering.Designs and
develops prevention and wellness initiatives.Establishes the
effective use of patient registries (CRISP and eMedicaid) as
applicable to manage specific patient populations and to improve
disease and population health outcome
measures.Collaborates/consults with specialty practices to identify
data needs related to care coordination.Monitors participants'
monthly visits to assure the appropriate population home are
delivered.Oversees the entering of all required data Performs
comprehensive assessments of physical, emotional, psychosocial and
environmental needs of participants and develop care plans for all
assigned Population Health enrollees around physical health or
social goalsFacilitates health education groupsAssesses,
coordinates and implements service planning needs of assigned
personsEvaluates/assists in evaluation of appropriateness of plan
of care and revises on an ongoing basis with communication to all
other disciplinesReviews results of laboratory tests and other
diagnostic procedures and reports to the nurse practitioner or
psychiatristIdentifies significant clinical findings, makes
conclusions and intervenes appropriately under the direction of the
nurse practitioner consultantCompares ongoing outcome data to
baseline data to monitor clients.Initiates client education based
on identified learning needs of the client and/or those providing
care and documents appropriatelySupports and monitors compliance of
the individual including checking of prescription labels and
storageConsults with behavioral health staff about participants'
identified health conditionsAttends treatment team meetings with
behavioral health staff to plan and coordinate careAssists in
contacting medical providers & hospitals for coordination of care
effortsProvides training on medical diseases, treatments, &
medications to health home participants.Assists in the training and
education of OTP staff regarding population health
services.Provides training on medical diseases, treatments, &
medications to behavioral health staff, as indicatedTakes action to
correct observed risks to patient safetyReports adverse events and
near misses to supervisorImplements policies, procedure, and
standards consistently in the performance of assigned
dutiesDevelops effective working relationships and maintains good
communication with other team members. Identifies possible risks in
processes, procedures, devices and communicates the same to those
in charge.Other duties as assignedOn-Call and willing to work a
Saturday when neededSchedule 6-2 Monday-Friday; remote 1 day a
week
Education and Experience: - Must Haves: -Licensure as a Registered
Nurse in the state of Maryland, or eligible to practice due to
Compact state agreements outlined through the MD Board of Nursing,
is required.Demonstrated success in exhibiting teaching, coaching,
and development skills.Demonstrated effectiveness in a consultative
role, and experience leading complex change.Ability to create a
motivating environment for clinical and professional
personnel.Highly effective interpersonal, verbal, and written
communication and presentation skills. The successfulDemonstrate
effectiveness in education others on a broad spectrum of health
issuesDemonstrate ability to collaborate with a multidisciplinary
treatment team.Strong sense of teamwork and collaboration, as
caseload coverage is shared amongst the entire Population Health
Nurse Care team and all aspects of services are further coordinated
with several multi-disciplinary teams Knowledge of the Maryland
healthcare industry and policy preferred.Ability to conduct online
research to source information and resources for clients
preferredKnowledge of area resources and case management
preferredAbility to analyze and conceptualize data to ensure
achievement of desired outcomes.Technically proficient in Microsoft
Office programs and database use. Ability to learn and use an
electronic medical record and health information exchange to enter
clinical information and run reports.PandoLogic.
Category:Healthcare, Keywords:Population Health Nurse,
Location:BALTIMORE, MD-21201
Keywords: Kolmac, Eldersburg , Population Health Nurse Care Manager, Healthcare , Baltimore, Maryland
Click
here to apply!
|