Population Health RN - LAI Nurse Coordinator (12-Month Contract; Remote; Oregon-Based)

Thank you for your interest in career opportunities at Central City Concern!

Since 1979, the Portland Community has trusted Central City Concern (CCC) to help people create meaningful, long-term change. Every year, we serve more than 13,000 people experiencing, or at risk-of, homelessness with affordable and supportive housing, person-centered health care, addiction recovery and employment assistance. By providing health care, housing and jobs, CCC is ending homelessness in Portland and helping people achieve their highest potential. 

Now Hiring: Join Central City Concern as our *Population Health RN - LAI Nurse Coordinator

Location: Remote (*Note: Candidates must be Oregon-based)

Schedule: Full-Time (Monday-Friday; 8:00am-4:30pm)

Compensation: $44 - $57/hour (depending on years of experience as a licensed RN + internal equity)

ROLE SUMMARY: The LAI Nurse Coordinator on the Population Health Team provides comprehensive community health services directed towards the prevention of disease, the promotion of health, and the client’s self-care using professional judgment in comprehensive assessment, screening, nursing diagnosis, care planning, health information /education, referral and evaluation. The LAI Nurse Coordinator supports primary care in providing assessment and outreach to promote continuity of care and health promotion across multiple clinic sites.

MINIMUM QUALIFICATIONS (REQUIREMENTS)

1. Required: Successful completion of a course of accredited study that leads to the AD, or BS or AA degree in Nursing from OSBN or State Board-approved course.
2. Required: Current RN license in the State of Oregon
3. Required: At least one (1) year of nursing experience in care management, telephonic client care or population health management.
4. Required: Must be a resident of the State of Oregon and live in Oregon.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

Client Care

1. Supports Primary Care Team and Pharmacy in coordinating the scheduling and administration of Long Acting Injectables (LAIs) for patients that are prescribed.
2. Follow up on clients who are currently admitted or recently discharged from the hospital or Emergency Department for Mental Health concerns, assessing client needs for follow up, providing education and connecting them to other services.
3. Perform telephone outreach to clients, other CCC service providers, and patient-identified supports to facilitate non-coercive care gap outreach to patients. Outreach is based on population health indicators to improve the health of the client and to prepare CCC for a value-based payment Care gaps include but are not limited to:
   • Completion of routine preventive services;
   • Follow up for chronic disease management;
   • Follow up after hospitalization;
   • Re-engagement of patients who have not had a recent appointment; and
   • Engagement of attributed patients who have yet established care.
4. Perform telephone triage as Provides instruction, training, and health information on self-care and health maintenance as per the clients care plan.
5. Adhere to all state and federal privacy regulations, including HIPAA and 42 CFR Part 2, and to CCC policies and agreements regarding confidentiality, privacy, and security. Support compliance with all privacy and security requirements pursuant to community partners’ and outside providers’ patient confidentiality agreements, including privacy and security requirements for EMR access. This includes immediately reporting any breach of protected health information or personal identification information of any person receiving CCC services by CCC or an outside provider to the CCC Compliance Department, as well as to your supervisor or their designee.
6. Directs and assigns the care of individuals & groups of clients to members of the team based on the scope of practice and clinical skills needed by the clients.
7. Assures client follow-up as needed for abnormal labs, specialty/referral reports, clinical treatment and prescriptions, etc.

SKILLS AND ABILITIES:

1. Working knowledge of principles, practices and procedures of telephonic patient
2. Working knowledge of principles of continuity of care, population health management and programs and services available to clients
3. Working knowledge in how to access, interpret and apply computerized client data information.
4. Ability to display a non-judgmental attitude and show diplomacy and tact, and work with a wide range of constituencies in a diverse community.
5. Ability to work courteously and communicate effectively with patients, co-workers, program staff, and the public at large, including maintaining professional and appropriate interactions in stressful situations.
6. Ability to work as a team member and to establish priorities.
7. Ability to apply principles learned to new situations.
8. Ability to work independently, manage time, meet deadlines and to respond flexibly and positively to change.
9. Sufficient manual dexterity and physical ability to perform assigned tasks.
10. Ability to communicate clearly and concisely both orally and in writing.
11. Sound decision-making skills and excellent professional judgment, including ability to handle sensitive and confidential information on a daily and ongoing basis.
12. Ability to maintain accurate records (paper and electronic) and appropriately complete and route necessary paperwork.
13. Knowledge of de-escalation methods or ability to be trained in de-escalation methods.

Central City Concern is a second chance employer and complies with applicable laws regarding consideration of criminal background for employment purposes. Government regulations, contractual requirements, or the duties of this particular job may require CCC to conduct a background check and take appropriate action to address prior criminal convictions.