Working title: Registered Nurse Case Manager
Classification title: Registered Nurse
Division: Family Health Services
Program: Nurse Family Partnership
Reports to: RN Supervisor
FLSA status: Non-Exempt; Full-time
Schedule: Monday-Friday 8am-5pm
Wage Range: $29.98 to $42.26 hourly; plus an additional $2/hr pay add-on for case management; depending on number of years of transferrable experience and internal equity
Serving the Yellowstone County community and south-central Montana for nearly 50 years, RiverStone Health is an essential provider of personal and public health services. Health, Education, Leadership and Protection – HELP is what we do.
From medical, dental and behavioral healthcare; home care and hospice; public health services like immunizations, WIC, health promotion and restaurant inspections; and educating the next generation of health professionals, our expertise spans all ages and stages of life. Underlying principles of access, affordability, compassion and quality in all interactions, RiverStone Health improves life, health and safety for all of the communities we serve.
Foremost, we are committed to the values of Justice, Equity, Diversity and Inclusion (JEDI) by cultivating an environment that protects and acknowledges the unique identities within our diverse community.
Family Health Services (FHS) are available to pregnant women and families with infants and children birth to 18 years of age. Alone or in combination, a team of nurses and resource workers help families to reach their goals and improve their family’s life, health, and safety. Nurse Family Partnership is an evidence-based program under the umbrella of FHS that serves expectant parents and their children until the child’s 2nd birthday.
NURSE FAMILY PARTNERSHIP (NFP) REGISTERED NURSE
A Nurse Home Visitor provides comprehensive nursing services to pregnant women and their children eligible for the NFP Program. The nurse adheres to the NFP model and guidelines while educating, connecting with, and providing referrals and resources to clients.
Nursing Services 60%
- Welcomes patient/family, establishes rapport and answers any questions regarding treatments, immunizations, beneficial health practices, disease prevention, or care plans. Responds to patients questions and comments in a courteous and timely manner. Accommodates language or literacy barriers and special needs of patient/parents to make them feel comfortable and informed about procedures.
- Provides case management and health education services to patients and their families in the community, their homes, personal care homes, or specialized programs.
- Makes initial patient evaluation visit and assessment, including taking patient medical histories. Performs regular follow-up assessments of patients’ status and adjusts treatments as necessary. Maintains documentation such as clinical and progress notes, vaccine records, treatment plans, and maintains other appropriate records.
- Informs the primary medical provider of any changes in patient’s condition or needs and coordinates any modifications in treatment with other appropriate personnel.
- Assesses and determines the physical, social, and environmental needs of clients and develops a plan of treatment with other team members.
- Provides skilled comprehensive nursing care and implements health care plans, immunizations, and treatments for patients. Maintains all sanitary and aseptic techniques throughout procedures.
- Administers prescribed oral and injected medications as directed by a licensed medical provider and Dispenses medication to patients as required.
- Participates in discharge planning for patients and/or reviews comfort measures and after care instructions with patient/parents.
- Communicates and coordinates regularly with appropriate others to maximize the effectiveness and efficiency of interagency operations and activities. Participate in program quality improvement projects
- Keeps immediate supervisor and designated others accurately informed concerning work progress, including present and potential work problems and suggestions for new or improved ways of addressing such problems.
- Attends meetings, conferences, workshops, and training sessions and reviews publications and audio-visual materials to become and remain current on principles, practices, and new developments in assigned work areas.
Nurse Family Partnership 35%
- Conducts unaccompanied home visits at client/family residences or other public settings on routine basis.
- Adheres to NFP model for visiting schedule, education, and client interactions.
- Provides skilled comprehensive nursing care and implements health care plans for clients.
- Provides referrals to community resources.
- Provides on-going emotional support and acts as an advocate for clients with other community support services and organizations.
- Assesses and determines the physical, social, and environmental needs of clients.
- Coordinates with primary care provider on behalf of client when needed.
- Prepares progress notes and maintains other appropriate records.
Non-Essential Functions/Other duties as assigned 5%
- Perform other duties as assigned in support of the organization’s mission and goals.
Minimum Qualifications
- Associate's Degree in Nursing
- Experience working with Pediatrics, Labor and Delivery, Maternal Child Health, or other Maternal Child Health home visiting
- Certification by the American Heart Association (AHA) for Basic Life Support (BLS)
- Any combination of experience and training which provide the equivalent scope of knowledge, skills, and abilities necessary to perform the work.
Preferred Qualifications:
- Certified Lactation Counselor (CLC); required within 2 years of employment.
- Bachelor's degree in Nursing
- Current license as a Registered Nurse in the State of Montana
- Valid State of Montana Driver’s License and vehicle insurance
- BLS Certification
- Knowledge of principles and processes for providing customer and personal services. This includes customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction.
- Knowledge of the information and techniques needed to diagnose and treat human injuries, diseases, and deformities. This includes symptoms, treatment alternatives, drug properties and interactions, and preventive health-care measures.
- Thorough knowledge of nursing techniques and their relation to medical and surgical practice.
- Thorough knowledge of public health principles and practices, preventive measures, and knowledge of community resources.
- Thorough knowledge of the skills necessary to provide care appropriate to patients served.
- Knowledge and understanding of protected sensitive patient health information (HIPAA) and confidentiality.
- Doing things right the first time
- Making people feel welcome
- Showing respect for each customer
- Anticipating customer needs and concerns
- Keeping customers informed
- Helping and going the extra mile
- Responding quickly
- Protecting privacy and confidentiality
- Demonstrating proper telephone etiquette
- Taking responsibility for handling complaints
- Being professional
- Taking ownership of your attitude toward Service Excellence.
- Work is performed in patient homes, community setting, etc.
- Expected to drive a vehicle which requires sitting, seeing and reading signs, traffic signals, other vehicles, etc. Travel occurs in all weather conditions, including extreme heat and cold; within Yellowstone County
- Frequent sit, use of hands and fingers, talking and hearing
- Extended periods of time sitting
- Lifting of 25 lbs on routine basis
- Works under the direction of an RN Supervisor. Work is structured by public health regulations and established nursing practices. The position makes independent professional judgements regarding patient health. Decisions directly affect the quality of services provided to the public.
- Contacts occur both inside and outside RiverStone Health and typically are for the purposes of rendering services to patients to gather information and provide education and instruction.
- Contacts are often non-routine and may require use of approaches that consider the needs, concerns or unique circumstances surrounding particular patients.
- Hostility, debate or conflict may be characteristic of some patient contacts.
- Communication with others is a critical element of the position because the purpose of the contact may be to negotiate matters involving significant issues of importance.
- Work directly with other care team members to provide wholistic care for patients.
- Act as a resource for clerical staff to resolve matters concerning procedures, patients, and appointments.
- Respond to citizens’ questions and comments.
- Communicate and coordinate with others to maximize the effectiveness and efficiency of interagency operations and activities.
COMPETENCIES AND SKILLS: Staff’s skill levels must align with priority Core Competencies for Public Health Professionals’ appropriate for the staff, Tier 1 level[1].
Analytical/Assessment Skills
- Describes factors affecting the health of a community (e.g., equity, income, education, environment)
- Selects comparable data (e.g., data being age-adjusted to the same year, data variables across datasets having similar definitions)
- Describes public health applications of quantitative and qualitative data
- Contributes to assessments of community health status and factors influencing health in a community (e.g., quality, availability, accessibility, and use of health services; access to affordable housing)
- Explains how community health assessments use information about health status, factors influencing health, and assets and resources
Policy Development/Program Planning Skills
- Contributes to state/Tribal/community health improvement planning (e.g., providing data to supplement community health assessments, communicating observations from work in the field)
- Contributes to development of program goals and objectives
- Describes organizational strategic plan (e.g., includes measurable objectives and targets; relationship to community health improvement plan, workforce development plan, quality improvement plan, and other plans)
- Contributes to implementation of organizational strategic plan
- 2A5 Identifies current trends (e.g., health, fiscal, social, political, environmental) affecting the health of a community
- Gathers information that can inform options for policies, programs, and services (e.g., secondhand smoking policies, data use policies, HR policies, immunization programs, food safety programs)
- Describes implications of policies, programs, and services
- Implements policies, programs, and services
- Gathers information for evaluating policies, programs, and services (e.g., outputs, outcomes, processes, procedures, return on investment)
- Applies strategies for continuous quality improvement
Communication Skills
- Identifies the literacy of populations served (e.g., ability to obtain, interpret, and use health and other information; social media literacy)
- Communicates in writing and orally with linguistic and cultural proficiency (e.g., using age-appropriate materials, incorporating images)
- Suggests approaches for disseminating public health data and information (e.g., social media, newspapers, newsletters, journals, town hall meetings, libraries, neighborhood gatherings)
- Conveys data and information to professionals and the public using a variety of approaches (e.g., reports, presentations, email, letters)
- Communicates information to influence behavior and improve health (e.g., uses social marketing methods, considers behavioral theories such as the Health Belief Model or Stages of Change Model)
- Describes the roles of governmental public health, health care, and other partners in improving the health of a community
Cultural Competency Skills
- Describes the concept of diversity as it applies to individuals and populations (e.g., language, culture, values, socioeconomic status, geography, education, race, gender, age, ethnicity, sexual orientation, profession, religious affiliation, mental and physical abilities, historical experiences)
- Describes the diversity of individuals and populations in a community
- Describes the ways diversity may influence policies, programs, services, and the health of a community
- Recognizes the contribution of diverse perspectives in developing, implementing, and evaluating policies, programs, and services that affect the health of a community
- Addresses the diversity of individuals and populations when implementing policies, programs, and services that affect the health of a community
- Describes the effects of policies, programs, and services on different populations in a community
4A7. Describes the value of a diverse public health workforce
Community Dimensions of Practice Skills
- Describes the programs and services provided by governmental and non- governmental organizations to improve the health of a community
- Recognizes relationships that are affecting health in a community (e.g., relationships among health departments, hospitals, community health centers, primary care providers, schools, community-based organizations, and other types of organizations)
- Engages community members (e.g., focus groups, talking circles, formal meetings, key informant interviews) to improve health in a community
- Provides input for developing, implementing, evaluating, and improving policies, programs, and services
- Informs the public about policies, programs, and resources that improve health in a community
- Describes the importance of community-based participatory research
Public Health Sciences Skills
- Describes how public health sciences (e.g., biostatistics, epidemiology, environmental health sciences, health services administration, social and behavioral sciences, and public health informatics) are used in the delivery of the 10 Essential Public Health Services
- Retrieves evidence (e.g., research findings, case reports, community surveys) from print and electronic sources (e.g., PubMed, Journal of Public Health Management and Practice, Morbidity and Mortality Weekly Report, The World Health Report) to support decision making
- Describes evidence used in developing, implementing, evaluating, and improving policies, programs, and services
Financial Planning and Management Skills
- Adheres to organizational policies and procedures
- Describes public health funding mechanisms (e.g., categorical grants, fees, third-party reimbursement, tobacco taxes)
- Provides information for proposals for funding (e.g., foundations, government agencies, corporations)
- Describes financial analysis methods used in making decisions about policies, programs, and services (e.g., cost-effectiveness, cost-benefit, cost- utility analysis, return on investment)
- Operates programs within budget
- Describes how teams help achieve program and organizational goals (e.g., the value of different disciplines, sectors, skills, experiences, and perspectives; scope of work and timeline)
- Uses evaluation results to improve program and organizational performance
- Uses performance management systems for program and organizational improvement (e.g., achieving performance objectives and targets, increasing efficiency, refining processes, meeting Healthy People objectives, sustaining accreditation)
Leadership and Systems Thinking Skills
- Incorporates ethical standards of practice (e.g., Public Health Code of Ethics) into all interactions with individuals, organizations, and communities
- Describes public health as part of a larger inter-related system of organizations that influence the health of populations at local, national, and global levels
- Describes the ways public health, health care, and other organizations can work together or individually to impact the health of a community
- Contributes to development of a vision for a healthy community (e.g., emphasis on prevention, health equity for all, excellence and innovation)
8A5. Identifies internal and external facilitators and barriers that may affect the delivery of the 10 Essential Public Health Services (e.g., using root cause analysis and other quality improvement methods and tools, problem
Required
Preferred
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Bachelors or better in Nursing
Required
Preferred
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Dedicated: Devoted to a task or purpose with loyalty or integrity
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Loyal: Shows firm and constant support to a cause
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Functional Expert: Considered a thought leader on a subject
Preferred
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Ability to Make an Impact: Inspired to perform well by the ability to contribute to the success of a project or the organization
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Self-Starter: Inspired to perform without outside help
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Work-Life Balance: Inspired to perform well by having ample time to pursue work and interests outside of work