Job Title

POSITION SUMMARY: Perform the duties required to coordinate and monitor provision of wellness and prevention initiatives for patients enrolled in Primary Health Homes. POSITION QUALIFICATION REQUIREMENTS Education: Registered Nurse Diploma or Bachelor of Science in Nursing. Experience: Three (3) years as an RN in community clinic, public health nursing, and/or hospital setting; including dispensing sample drugs and monitoring effects. Skills and Abilities (which may be representative but not all inclusive of those commonly, associated with this position): * Good computer skills including the use of word processing and e-mail software. * Good oral and verbal communication skills. * Good organizational and self-motivation skills. * Ability to maintain confidentiality. * Ability to motivate and educate clients and staff. Transportation Requirement: Must possess a valid driver's license and automobile with insurance coverage as required by the State of Missouri. License(s)/Certificate(s): Licensed as RN in the State of Missouri; CPR certification. FUNCTIONS OF THE JOB Essential Functions * Enrollment and management of required caseload. Completing monthly touches per regulations/guidance. * Assist in developing treatment plan health care goals for individuals with co-occurring chronic diseases. * Develop wellness and prevention initiatives. * Facilitate health education groups. * Keep patients' records. Complete appropriate forms and reports. Provide appropriate documentation. Adhere to patient confidentiality. * Participate in the initial treatment plan development for all Primary care health home enrollees. * Assist in contacting medical providers and hospitals for admission/discharge. * Provide training on medical diseases, treatments, and medications. * Initiate the referral of high-risk patients and families for special services, team management, and track the patient's referral (i.e.) abnormal lab results. * Collaborate with behavioral health and medical teams to develop patient-centered plan of care. * Track required assessments and screenings. * Assist with referrals to community and social support services. * Assist in implementing MHD health technology programs and initiatives (i.e., Cyber Access, metabolic screening). * Monitor HIT tools and reports for treatment. * Medical alerts and hospital admissions/discharges. * Monitor and report performance measures and outcomes. * Consult with Community Support Staff regarding identified health conditions. * Perform other duties as assigned. Marginal Functions: * Assist providers with enrolled patients, take and record vital signs as necessary, review and report abnormal results. * Observe for abnormal signs and symptoms, document, and report to provider. * Assist with implementation of Quality Improvement Programs. * Attend mandatory meetings and training courses. * Submission of monthly reports as scheduled. Supervises: None NOTE: SMOKING IS PROHIBITED IN THE WORK ENVIRONMENT NOTE: ALL APPLICANTS MUST PROVIDE CONTACT INFORMATION FOR THREE REFERENCES AN EQUAL OPPORTUNITY SERVICES PROVIDED ON A NON-DISCRIMINATORY BASIS