Description

Functions as a lead of the health care team, provides professional nursing care, utilizing the nursing process in accordance with established standards of care, policies, and procedures. Demonstrates performance consistent with the organization’s Vision, Mission, and Strategic Plan. Remains flexible to changing systems; is expected to demonstrate quality and effectiveness in work habits and clinical practice; and treats co-workers, patients, families, and all members of the health care team with dignity and respect. Coordinates departmental operations that ensure quality patient care in a safe, healing environment that is patient and family centered. Demonstrates responsibility and accountability for own professional practice. Has appropriate clinical skills to be an expert resource. Is available and supportive to employees and understands priorities/needs of the department. Is a staff role model for professional nursing practice.

ESSENTIAL JOB DUTIES AND RESPONSIBILITIES:

1. Supports and implements the organization’s vision, mission, and values.
2. Determines priorities to complete daily workload to ensure that all responsibilities are carried out in a timely manner.
3. Answers phone calls and e-mails in a timely manner with excellent customer service internally and externally.
4. Uses effective relationship management, coordination of services, resource management, education, patient advocacy, and related interventions to promote improved quality and continuity of care.
5. Assists in the compliance, accuracy, and timeliness of standards in accordance with CMS, NCQA, DHCS, Health Plan, and other federal regulations.
6. Monitor, provide, and document all incoming triage requests from Patients, Providers, and other sources on EPIC.
7. Provide professional nursing assessments, prioritize treatments according to the urgency of need, and initiate medical care to patients as needed.
8. Recommends process improvement measures to achieve department’s performance and goals.
9. Functions as a charge nurse and is responsible for identifying the needs to achieve the department’s performance including but not limited to maintaining compliance of current regulations set forth by governing bodies, assisting in the development of programs, training materials, orientations, and other functions necessary to meet the Health Center’s needs.
10. Conducts regular audit activity via department's performance reporting standards to maintain quality care of members and compliance of regulatory requirements.
11. Provides report to direct manager and organizational leadership to identify trends and improve workflow processes.
12. Ensures department compliance with Health Insurance Portability and Accountability Act (HIPAA) regulations relating to protection of personal history information (PHI).
13. Assures personnel are competent in their job responsibilities through appropriate licensure, orientation, annual competencies, and the successful completion of an annual employee evaluation. The annual competencies are based upon specific tasks that are utilized in daily operations and impact patient outcomes.
14. Attends all mandatory meetings, in-services and staff meetings as required, actively participates in other departmental professional development.
15. Coordinates care with health plans, hospitals, IPA, and other professionals involved with patient care as needed.
16. Administer medications, perform medication education, complete medication reconciliation, pack medications for members, and communicate with providers, and other members of the multidisciplinary health care team.
17. Provides nursing care consistent with Nursing Standards of Care/Practice and QHC’s Code of Conduct.
18. Supervise vaccine administration and adheres to the “Five Rights of Medication Administration” to help ensure the right drug, right dose, right route, and right patient at the right time. Assesses all patients for allergies or previous reactions to antigens.
19. Responsible for the smooth and efficient patient flow within the clinic. Delegates assignments and provides supervision for the support staff in accordance with their level of training and the patient’s acuity.
20. Manages medical inventory, and ensures the safe storage of prescription drugs, vaccines, and controlled substances.
21. Collaborates with physicians, other members of the multidisciplinary health care team, and patient/family in the development, implementation, and documentation of appropriate care to ensure continuity, quality and appropriate resource use related to Care Management.
22. Assist with managing acute episodes of a specific disease state, with the goal of preventing further progression of the disease.
23. Assist in the implementation of programs such as vaccine clinics (MyTurn), to optimize patient satisfaction.
24. Assists, develops, and maintains case management policies and procedures. Coordinates, directs, and performs concurrent and retrospective reviews, and monitors level and quality of care.
25. Consults with internal and external physicians, health care providers, discharge planning and outside agencies regarding continued care/treatment or hospitalization.
26. Encourages patients to follow prescribed course of care (e.g., drug therapy, physical therapy). Makes referrals to appropriate community services.
27. Interprets regulations, health plan benefits, policies, and procedures for members, physicians, medical office staff, contract providers, and outside agencies.
28. Acts as liaison for outside agencies, non-plan facilities, and outside providers. In conjunction with physicians, evaluates and develops treatment plans, recommends alternative levels of care, and ensures compliance with federal, state, and local requirements.
29. Participates in committees, teams or other work projects/duties as assigned.
30. Other duties assigned.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION/EXPERIENCE:

1. Graduate of an accredited school of nursing.
2. Bachelors degree in nursing or health related field.
3. High school, GED, or equivalent work experience is required.

LICENSE, CERTIFICATION, REGISTRATION:

• Registered Nurse License (California)

ADDITIONAL REQUIREMENTS:

1. Knowledge of Nurse Practice Act, The Joint Commission, and other federal/state/local regulations.
2. Must be able to work in a Labor/Management Partnership environment.

LANGUAGE SKILLS:

Ability to read and interpret documents, such as policies and procedures, surveys, board minutes, routine mail, simple contracts, and procedure manuals. Ability to compose routine reports and correspondence. Ability to speak effectively with employees and management.

MATHEMATICAL SKILLS:

Ability to calculate figures and amounts such as discounts, interest, proportions, percentages, and the ability to apply concepts of basic algebra, statistics, and geometry.

REASONING ABILITY:

Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations. Ability to apply common sense to daily situations that arise. Ability to make decisions and execute timely to produce a positive outcome.

OTHER SKILLS AND ABILITIES:

1. Strong organizational skills, with the ability to manage several projects at the same time.
2. Ability to work effectively with all levels of the organization and stakeholders, including communication with clients, patients, and health plan executives in an utmost professional manner.
3. Ability to determine key issues and develop action plans.
4. Must be able to demonstrate a positive healthy attitude.
5. Flexible and dependable.
6. Fosters and promotes a culture of service excellence and accountability.
7. Performs all job functions in a professional and courteous manner.
8. Maintains and promotes a safe and healthy work environment.
9. Excellent communication skills, both oral and written.
10. Demonstrates proficiency in computer applications essential for the role.
11. Ability to organize and prioritize work with minimum supervision.
12. Ability to manage time efficiently and follow through on duties to completion.
13. Understands and commits to maintaining the highest level of confidentiality.
14. Ability to build a positive rapport with patients, staff, colleagues, and other external contacts.
15. Excellent problem-solving skills required, including creativity, resourcefulness, timeliness, and technical knowledge related to analyzing and resolving clinical problems.
16. Sensitivity to needs of culturally and linguistically diverse patient and employee population.