RN - Population Health - FT - Days - MHS
Company: Memorial Healthcare System
Location: Hollywood
Posted on: May 23, 2025
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Job Description:
Location:Hollywood, FloridaWe have an outstanding reputation for
providing patient- and family-centered care that exceeds all
expectations. Together, we have created an award-winning,
nationally-recognized system where every effort is focused on
delivering Deeper Caring and Smarter Healthcare throughout our
communities. Career opportunities exist on diverse teams across our
many facilities where you can search open positions and apply
online to join #teamMHSflorida.Learn more below.SummaryUnder the
direction of the Population Health Management leadership, the
Population Health Registered Nurse (PHRN) serves as a liaison
between the Memorial Healthcare System (MHS), Memorial Health
Network (MHN), Broward Guardian, ACHN, Memorial Physician Group
(MPG), community providers, post-acute care facilities, external
healthcare organizations, and the patient. The PHRN follows nursing
processes and protocols and implements systems of care that
facilitate care coordination and close monitoring of specially
defined, high and rising risk patient populations attributed to
value-based programs or MHA. The PHRN fosters an inter-professional
team-based approach ensuring continuity of care extends beyond the
acute care boundaries. The PHRN roles can include a focus on care
management, quality, post-acute transitions, remote patient
monitoring, care coordination or all of the
above.ResponsibilitiesPerforms concurrent medical record review
using specific indicators and criteria established by the
Population Health Nurse II. Monitors the quality, frequency and
appropriateness of healthcare delivery by post-acute providers and
reports variations of plan of care, health status, or psychosocial
issues to PCP and appropriate members of the care team. Promotes
effective and efficient utilization of clinical resources and
mobilizes resources to assist in coordination of care across the
healthcare continuum.Chronic condition management including remote
patient monitoring referral process, which includes, but is not
limited to, eligibility assessment, medical record extraction,
provider/physician order entry, patient consent, handoff
communications and escalation of abnormal values. Provides
telephonic triage and monitoring using established disease-specific
protocols. Through utilization of remote patient monitoring
technology and other tools, responds to customers' written, or
telephonic communications or inquires with respect to disease
management.Supports, participates, and coordinates in preparation
and completion of quality audits, quality reporting and regulatory
reviews. Collaborates closely with the Population Health Management
leadership and Population Health Service Organization Business
Intelligence teams to review and provide input on utilization
trends. Participates in ongoing process improvement activities
through the application of clinical paths, QA processes and other
related activities. Ensures that remote patient monitoring
processes and customer services are continuously monitored for
quality, cost effectiveness, and efficiency.Responsible for
longitudinal patient engagement in remote patient monitoring
program. Participates in ongoing process improvement activities
through the application of clinical paths, QA processes and other
related activities. Ensures that processes and services are
continuously monitored for quality, cost effectiveness, and
efficiency.Conducts initial intake, assessment, identifies and
manages health and safety risks including assessment of social
determinants of health, functional status, health risk assessment,
and medication clarification and education. Discusses assessment
with Population Health Nurse II for co-signature on assessment. As
appropriate, discusses patients' eligibility for population health
management services or disease management programs. Assesses
patient/caregiver capacity and willingness to participate in such
programs.Follows the patient-family centered care plan developed by
the Population Health Nurse II. Initiates patient conference with
Population Health Nurse II for modifications to care plan. Under
the guidance of the Population Health Nurse II provides telephonic
care/case management services including but not limited to health
risk assessment, medication clarification, clinical-decision
making, remote patient monitoring, and disease management for
rising to high risk patient population. Applies evidence-based
clinical guidelines and protocols to promote high quality
healthcare delivery.CompetenciesACCOUNTABILITY, ANALYSIS AND
DECISION MAKING, CLINICAL POLICIES AND STANDARDS, CUSTOMER SERVICE,
DISEASE MANAGEMENT, PATIENT AND FAMILY CENTERED CARE, RESPONDING TO
CHANGE, STANDARDS OF BEHAVIOR, TEAM WORKEducation And Certification
RequirementsAssociates: Nursing (Required)Registered Nurse Compact
License (RN LICENSE COMPACT) - Compact RN Multistate, Registered
Nurse License (RN LICENSE) - State of Florida (FL)Additional Job
InformationComplexity of Work: This role requires critical thinking
skills, effective communication, decisive judgment, and the ability
to build and foster positive relationships. The incumbent must be
able to take appropriate action when required. Ability to travel to
Memorial Healthcare System locations or post-acute care facilities
when needed. Required Work Experience: Three (3) years of
healthcare experience. Excellent written and oral skills, with the
ability to engage, inspire, build credibility and trust with peers
and patients. Collaborative working style with the ability to work
across different teams, areas of expertise, and adapt to various
environments and clientele. Highly organized and self-motivated
individual with ability to adapt to various assignments and ability
to work autonomously. Other Information: Minimum: Associate of
Science in Nursing; Bachelor of Science in Nursing
(preferred).Additional Education Info: Bachelor of Science in
Nursing (preferred)Working Conditions And Physical Requirements
Keywords: Memorial Healthcare System, Homestead , RN - Population Health - FT - Days - MHS, Healthcare , Hollywood, Florida
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