RN

Registered Nurse (RN)

Location: Western North Carolina Region

About Impact Primary Care Network: Impact Primary Care Network (IPCN) is a physician-led clinically integrated network (CIN) that is leading a new approach to delivering whole-person care in Western North Carolina (WNC). We are deeply invested in our patients health and the health of our rural region. Our care management platform and services are designed to seamlessly integrate social health support with clinical care to improve patient health outcomes. IPCN supports primary care practices that are participating in innovative population health initiatives like NC Medicaid s Healthy Opportunities Pilot and Medicare s Making Care Primary model. IPCN was founded by Impact Health, an Asheville-based nonprofit leading a network of more than 60 human service organizations participating in North Carolina s Healthy Opportunities Pilot. HOP is a groundbreaking initiative to improve health that uses Medicaid funding to support social drivers of health across four key domains of need: food, housing, transportation, and interpersonal safety and toxic stress.

Summary: We are seeking a compassionate and dedicated Registered Nurse (RN) to join our team. The RN will provide patient-centered care and health education to individuals and families within the community. This role involves working in collaboration with a multidisciplinary team to promote wellness, manage chronic diseases, and deliver preventative healthcare services.

Responsibilities & Duties:

• Responsible for enhancing the quality of care and patient management throughout the continuum of care and for assuring cost-effective care through clinical interventions, case management, education, chronic disease management, utilization review and management, and support of transitions of care.
• Conducts and documents clinical assessments and creates care plans for patients identified as having unmet needs or barriers to care.
• Provides support to patients, family, caregivers, providers and community agencies.
• Collaborates with network and community partners to effectively achieve positive individual and population outcomes, promote best practices, and improve healthcare delivery.
• Conducts visits with patients based on program guidelines.
• Assesses the "whole person needs of assigned patients by completing a comprehensive assessment, including review of functional abilities, Social Determinants of Health, clinical findings, medical records and current supports and services.
• Responsible for clinical management of high-risk identified patients.
• Understanding of major health conditions and social needs of assigned patient population with the ability to provide education, support and guidance in a patient centered manner.
• Creates, monitors and evaluates the effectiveness of the patient centered plan of care to address all assessed needs.
• Communicates clinical findings, recommendations and referrals to care team.
• Follows all applicable regulatory requirements related to clinical interventions and documentation.
• Supports network goals of managing clinical quality measures
• Proficiently uses population health platform and/or available data to identify patients at risk and target appropriate interventions.
• Support patients transitioning from one level of care to another by identifying and addressing needs and barriers related to successful transitions.
• Coordinates transition plans with patients, family, caregivers, providers and community agencies.
• Collaborates with patients and caregivers to identify needs for post-acute services, such as durable medical equipment, home health, outpatient services and community resources.
• Facilitates orders as indicated and follows through with referrals as appropriate.
• Communicates changes in plan of care and incremental goals to patient/family and caregivers.

Education/Certification: Current Registered Nurse (RN) license in North Carolina. Compact License accepted.

Work Experience: Prior experience in community health or public health nursing is preferred.

Knowledge, Skills, and Attributes:

• Strong communication and interpersonal skills
• Ability to work independently and as part of a multidisciplinary team demonstrating a strong capacity for self-management and approaches challenges with an entrepreneurial mindset.
• Culturally sensitive and able to work with diverse populations by exhibiting respect and understanding towards individuals from various cultural backgrounds.
• Commitment to health equity with dedication to promoting fairness in healthcare by actively working to reduce disparities and ensure that all individuals receive equitable access to quality care and resources.
• Willingness to pitch in by demonstrating a proactive and flexible attitude by stepping up to assist with tasks outside of primary responsibilities when needed.
• Comfort with unknowns and adapts easily to new and unpredictable situations, maintaining composure and problem-solving effectively when faced with uncertainty or incomplete information.
• Self-directed by demonstrating strong time management and prioritization skills, consistently delivering results and seeking out opportunities for growth and improvement.
• Able to identify gaps, speak out and implement solutions by proactively identifying areas for improvement, communicates concerns and opportunities for enhancement.
• Professional growth and career development: Maintains licensure, knowledge and competencies related to clinical care coordination and practices within their scope. Actively participates in all required team and organizational meetings and trainings. Pursues internal and external education and training opportunities. Prepares and delivers internal education to staff as appropriate. Seeks opportunities to participate in community initiatives and work groups as appropriate and approved by leadership.

What We Offer:

• Salary Range of $65,000 to $95,000
• All full-time team members can take part in a broad offering of competitive benefits, including: 100% employer-paid medical, dental, vision, STD, LTD, Life and AD&D insurance. Up to 6% match for 403b retirement contributions. Annual PTO (4 weeks) & Sick (2 weeks). 10 paid holidays, 5 paid Winter Break days.

Working Environment: This position requires visits to external sites that require driving to and from various locations. Applicants must be committed to living within and performing hybrid work from the 18-county region we serve. Position can be hybrid, working in a home/office environment with occasional

Our Commitment to Equity and Inclusion: Impact Health is committed to diversity, equity, and inclusion in our work and teams. We know that the rich diversity of perspectives and wisdom imperative to our purpose can only come from a wide variety of origins and life experiences. We strongly believe that creating a workplace where all team members thrive is critical to fulfilling our purpose in the communities we serve. We intentionally recruit, develop, and retain the most talented people from a diverse candidate pool. Qualified candidates are urged to apply and will receive consideration for employment without regard to race, color, ethnicity, sex, age, national origin, religion, sexual orientation, gender identity and/or expression, status as a veteran, and basis of disability or any other federal, state, or local protected class.