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Registered Nurse I
Ref No.: 19-07554
Location: Nashville, Tennessee
Pay Rate : $ 50.00 - 60.00 /Hour
Position Summary:
Plans, implements, and evaluates appropriate health care services to assist the customer throughout the continuum of care. Utilizes clinical skills to assess, coordinate, monitor and evaluate options and services in order to facilitate appropriate health care outcomes for customers. Responsible for educating and motivating customers to participate in wellness programs. Support health promotion, disease prevention, and care management services.

Essential Duties and Responsibilities:
• Outreach low to moderate risk customers for coordination of care, including HRA and internal referrals, and continuity of care management.
• Identify and address customer gaps in care, which may include primary care physician and specialist appointment scheduling.
• Provide clinical assessments, health education, and community resources to customers, as needed.
• Initiate contact with customer/caregiver/family, primary care physician, and health care providers/suppliers as needed.
• Develop customer's individualized plan of care, as well as communicate the plan of care to the customer.
• Document all encounters with the customers, practitioners and providers.
• Resolve any immediate issues for customers after screening.
• Evaluate each case for quality of care, document and report quality issues to the appropriate team.
• Other duties as assigned.

• Perform Health Risk Assessments (HRA) on Special Needs Plan (SNP) customers.
• Triage customers with an HRA to decide if they need further follow up.
• Refer high risk customers to case management in the local market
• Refer customers with Behavioral Health needs to the Enterprise Behavioral Health team
• Outreach to all customers with an HRA completion to develop a higher level care plan, if needed.
• Identify and address customer gaps in care, which may include primary care physician and specialist appointment scheduling.
• Provide clinical assessments, health education, and community resources to customers, as needed.
• Identify and develop community resources for customers to include: paying for medications, food, utilities and housing. Local referrals for tax and legal aid.
• Disease management education for chronic illnesses to include: diabetes, hypertension, CHF, COPD and others.
• Initiate contact with customer/caregiver/family, primary care physician, and health care providers/suppliers as needed.
• Develop customer's individualized plan of care, as well as communicate the plan of care to the customer.
• Conduct Interdisciplinary care team activities with the customer's complete health team, when necessary
• Document all encounters with the customers, practitioners and providers.
• Handle crisis calls
Quick learner with the ability to work in a fast-paced environment. Professional customer service and telephone skills. Technology savvy. Ability to multi-task in numerous integrated care systems at one time. Ability to utilize clinical skills to assess, coordinate, monitor and evaluate options and services in order to facilitate appropriate health care outcomes for customer. Be able to plan, implement, and evaluate appropriate health care services to assist the customer throughout the continuum of care. Responsible for educating and motivating customers to participate in wellness programs. Support health promotion, disease prevention, and care management services.