CenterWell
Healthcare
ClinicalCareNurse(RN)
“Clinical Care Nurse (RN) at CenterWell. Skills: Transitions of Care, Medicare Advantage Stars, Quality performance, Patient outcomes. Analyze clinical data and trends. Identify gaps in care”
What You'll Achieve.
Improve patient outcomes; Reduce avoidable ED utilization; Drive Medicare Advantage Stars; Drive quality performance; Prevent avoidable readmissions; Prevent avoidable return visits
Industry & Context.
Data analysis skills; Root cause analysis
What They're Looking For.
Must Have
Associate's degree in nursing, Bachelor's degree in nursing, Active, unrestricted RN license, 3+ years' clinical nursing experience, Proficiency with electronic health records, Proficiency with data analytics tools, Proficiency with Microsoft Office Suite, Willing to complete Basic Life Support training
Nice to Have
Knowledge of Medicare Advantage Stars, Knowledge of HEDIS, Knowledge of CAHPS, Knowledge of CMS quality requirements, Experience with Transitions of Care, Experience with hospital discharge, Experience with ER follow up programs, Clinical judgment, Data analysis skills, Ability to apply evidence-based practices, Excellent communication skills, Motivational interviewing skills, Commitment to health equity, Commitment to inclusiveness, Commitment to patient-centered care, Bilingual in English and Spanish, Basic Life Support trained
What You'll Do.
Analyze clinical data and trends
Identify gaps in care
Prioritize high-impact opportunities
Identify recently discharged patients
Coordinate post-discharge follow-up
Address root causes of utilization
Prevent avoidable readmissions
Prevent avoidable return visits
Conduct targeted patient outreach
Conduct targeted provider outreach
Close care opportunities
Provide tailored education
Conduct post-discharge outreach
Assess understanding of discharge instructions
Perform medication reconciliation
Monitor follow-up appointment adherence
Collaborate with providers
Collaborate with care team
Document outreach efforts
Document clinical interactions
Prepare patients for huddles
Participate in center huddles
Participate in high-risk rounds
Participate in quality improvement projects
Participate in provider education sessions
Participate in team huddles
Monitor progress toward goals
Identify barriers to goals
Develop innovative solutions
Improve clinical performance
Improve patient engagement
Support clinic operations
Facilitate center Wellness Events
Facilitate market-based Wellness Events
Maintain patient confidentiality
Document patient encounters
Follow organizational policies
How You'll Work.
Team & Collaboration
Interdisciplinary teams; Providers; Care assistants; Center administrators; Medical assistants; Pharmacy; Quality improvement staff; Center-based team; Interdisciplinary team
Communication Scope
Motivational interviewing
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