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One Health Integrated Care Management Nurse in Bozeman, Montana

Integrated Care Management Nurse

Full Time position

For all CHP region sites (Bozeman, Belgrade & Livingston)

POSITION SUMMARY:

The coordinator is a One Health employee with a specialized skill set or education and makes a significant contribution to the organization’s potential to achieve its mission . Under the direction of assigned One Health leadership , coordinators work with a high sense of initiative and responsibility to provid e guidance or work product in a specialty area .

Provides professional level nursing service focusing on assessment and implementation of the patient’s clinical care plan in order to improve health outcomes. Functions as a member of the primary health care team under the general supervision of CHP Regional Clinic Director.

ESSENTIAL JOB FUNCTIONS AND RESPONSIBILITIES :

Reasonable accommodation may be made to enable individuals with disabilities to perform the essential job functions.

Coordinator Duties and Responsibilities

  • Utilizing advanced specialty knowledge and/or skills, p rovides coordination of organizational projects , programs, grants etc.

  • F unction s in a self-directed and professional manner with both external and internal stakeholders .

  • Facilitates maintenance of and development of initiatives within service and business line functions.

  • Collaborates and communicates within teams and across organizational and business lines to involve appropriate stakeholders in development and maintenance of specialty area initiatives .

    Position Specific Duties and Responsibilities

  • Provide s medical care management services in collaboration with the provider care teams, resource coordinators, clinical pharmacists, and behavioral health consultants including offering support for the medical respite program through H uman Resource Development Council and Bozeman Health.

  • Creates individualized care plans for patients receiving care management services and shares these with the patients.

  • Ensures patients proactively identified through medical home workflows receive care management services and documentation supports compliance requirements.

  • Educates and counsels patients using easy to understand (health literate) language.

  • Make s referrals to community, health and social services and provide liaison with these services as indicated . Advocates for patients while maintaining relationships with community healthcare providers.

  • Perform laboratory tests, counsel and educate patients prior to and following physical exams and testing.

  • Identify patients’ problems or needs, determine which ones a clinician must evaluate and refer accordingly.

  • Maintains acceptable methods of charting and record keeping providing for consistent, organized patient care per clinic policies and procedures.

  • In coordination with clinical care teams, promote the smooth functioning of care delivery and addition of new lines of care management services.

  • Participate in Value Based Care delivery as it relates to care management and care transitions.

  • Trains and supports clinic staff in offering care management, including supporting provider team panel management .

  • Exemplifies a patient-centered care approach to each patient along each stage of the patient journey, while working as a key patient centered team member by communicating individual patient care needs to support the needs of patients served.  

  • Adheres to all One Health Policies and Procedures. 

  • Participates in performance optimization and risk management activities as required .  

  • Cooperates and abides by all elements of One Health’s Compliance Program.  

  • Provides exceptional customer service and models the mission of One Health when interacting with internal and external stakeholders promoting a positive image for the health center. 

  • Performs other duties as assigned or required with prior notification. 

    MINIMUM JOB QUALIFICATIONS:

    Education /Certificates/Licenses :

    Required

    • Nursing degree from an accredited nursing program

    • Current license i n state of practice

    • Valid driver ’s license

    • BLS certification upon hire

    P referred

    • Registered Nurse

    Experience:

    Required

    • One (1 ) year of experience in community health or related field such as Family Medicine, Primary Care, or hospital Case Management

    Preferred

    • Two years of community health and/or physician’s office experience

    • Two years of care management experience

Department

Nursing

Employment Type

Full-Time

Compensation

$30.40/hr to $32.34/hr (DOE) plus $3.50 locality for Boz/Bel and $2.30 for Livingston

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