RN, Health Coach Wellmed At Central Burleson In Burleson, TX

Opportunities At Wellmed

Part of the Optum family of businesses, we believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff, and non-patient-facing roles, you can make a difference with us as you discover the meaning behind Caring. Connecting. Growing Together.

The Rn Healthcare Manager

The Rn Healthcare Manager works in collaboration with the multidisciplinary care team to reduce ER utilization, hospital admissions, and readmissions. The Healthcare Manager supports the transition of high-risk patients from the inpatient to home setting and provides longitudinal care for patients with complex, chronic conditions and supporting the navigation of the healthcare system. Additionally, the Healthcare Manager assists in developing patient engagement by acting as an educator, resource, and advocate for patients and their families, thus optimizing quality of life. This position functions as an independent role within the clinic setting.

Primary Responsibilities:

• Utilizes population stratification tools, collaborating with the Provider and members of the interdisciplinary team to identify high-risk patients
• Completes transition of care processes to include:
• Prompt Provider follow-up
• Medication reconciliation post-discharge (MRPD) completion
• Contingency plans are provided and reviewed
• Post discharge needs [e.g., durable medical equipment (DME), social determinants of health (SDoH)] are addressed
• May perform longitudinal and/or proactive outreach assessments
• Creates referrals to appropriate agencies and community resources
• Establishes plan of care for patient and coordinates advance care planning
• Conducts Nurse Visits, Motivational Interviewing (MI) and Self-Management Goal (SMG) setting
• Provides comprehensive individual and/or group patient education
• Participates in daily huddles, weekly Patient Care Conference (PCC) meetings and prepares corresponding reporting, as required
• Maintains continued competence in nursing practice and knowledge of current evidence based practices
• Performs clinical tasks within the RN's scope of licensure as deemed by the state's board of nursing
• Performs intravenous (IV) hydration and IV medication administration, Foley catheterization, and wound care as needed
• Acts as a clinical resource and support for clinic staff, and may delegate to clinical staff as appropriate
• Performs accurate and timely documentation in the electronic medical record
• Performs all other related duties as assigned

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• Bachelor's degree in Nursing or Associate's degree in Nursing with 3+ years of ambulatory experience in a physician's office or clinical setting
• Registered Nurse with an active and unrestricted license to practice in the state of employment
• Current BLS certification
• Knowledge of chronic diseases, especially COPD/asthma, diabetes, CHF and IHD
• Proficient computer skills to work efficiently with electronic medical records
• This position requires Tuberculosis screening as well as proof of immunity to Measles, Mumps, Rubella, Varicella, Tetanus, Diphtheria, and Pertussis through lab confirmation of immunity, documented evidence of vaccination, or a doctor's diagnosis of disease

Preferred Qualifications:

• Acute care experience in hospital and home health settings
• Experience related to patient education and/or motivational interviewing skills and self-management goal setting
• Fluent written and verbal skills in English and Spanish
• Proven excellent verbal and written skills
• Proven excellent organizational and prioritization skills
• Proven solid interpersonal skills
• Proven ability to interact productively with individuals and with multidisciplinary teams
• Bilingual English/Spanish

Physical & Mental Requirements:

• Ability to lift up to 35 pounds
• Ability to push or pull heavy objects using up to 35 pounds of force
• Ability to sit for extended periods of time
• Ability to stand for extended periods of time
• Ability to use fine motor skills to operate office equipment and/or machinery
• Ability to receive and comprehend instructions verbally and/or in writing
• Ability to use logical reasoning for simple and complex problem solving

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The salary for this role will range from $58,800 to $105,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.