Clinical Nurse Educator (Remote CA Resident)

Job Title:

Clinical Nurse Educator

Job Requisition ID: 10731

Position Summary/Position

Under the direction of the Clinical Health Education Manager, the Clinical Nurse Educator is part of the overall population health strategy, to address Members’ holistic needs with chronic conditions and expertise as it relates to medical, pharmacological management, and care coordination. The Clinical Nurse Educator will exist within an infrastructure of a care coordination model, to assist in engaging Members into the right level of care and will collaborate with others in the health education, promotion & prevention team (as well as other internal IEHP teams) to facilitate regional strategy and community partnerships to drive collective impact. The Clinical Nurse Educator will work with the underserved and vulnerable population to provide health education in a culturally tailored way that engages Members to increase their readiness for behavior change and will serve to support a strategic multi-disciplinary team to drive improvement in regulatory HEDIS/MCAS performance care gaps.

Major Functions (Duties and Responsibilities)

1. In partnership with other care management team(s) such as Enhanced Care Management, Complex Care Management, Transitions of Care, and/or Pharmacy Team, participate in the warm hand-off for the Member’s Care Plan to support success in chronic condition self-management through the formulation of individualized wellness plans based on the assessment of members' medical condition, level of readiness and knowledge base, by utilizing various techniques that encourage and support behavioral, lifestyle changes and/or chronic condition education and goal setting.

2. Responsible for reviewing chart notes, electronic medical records, and/or relevant clinical information focused on but not limited to medical management and disease processes within compliance turnaround times and quality standards meeting regulatory requirements as defined by Department of Health Care Services, Center for Medicare & Medicaid Services, California Department of Managed Health Care, and National Committee for Quality Assurance.

3. Perform clinical review of Member’s medical history and provides education, training, and advocacy around care plan adherence, technical support/education for durable medication equipment, such as glucometer, self-monitoring blood pressure kit, asthma spacer, etc., medication administration, such as subcutaneous injections, and lifestyle change for activities/interventions focused on medical /chronic conditions driven to improve outcomes in Member HEDIS/MCAS care gaps.

4. Review and respond to interdepartmental tasks sent via MHK, Meditrac, Care Director, or any other systems that require to coordinate the care of the Member as necessary and with other departments such as Pharmacy, Member Services, Care Management/Behavioral Health, Compliance, and collaborate with those departments and teams to coordinate chronic condition care and close the referral loop with Member’s Provider.

5. Demonstrate effective documentation in Member Care Plan, and appropriate clinical care escalation when risk is identified and participate in case review conference with interdisciplinary teams, as needed to discuss ongoing needs of Members, which include, but not limited to disease progression and management review and consultation.

6. Maintain current and timely clinical knowledge around best practices for chronic condition management and attend seminars and trainings to learn about different disease states and evidence-based approaches to effective health management.

7. Communicate with Providers and Members to provide information and assistance as appropriate and facilitate and coordinate follow-up with Provider, as necessary to support coordination of care and utilize Member engagement tools and styles to motivate, inspire, and shift Members to higher readiness for actions that support disease management and delay disease progression.

8. Partner with the Quality Teams to understand tiered risk populations and select opportunities for greatest impact surrounding health maintenance and delaying disease progression.

9. Support overall IEHP and Departmental-level Strategic Goals related to disease management and progression and support regional strategies and priorities and collaborate with organizational priorities driven to address health disparities and inequities.

10. Foster and maintain strategic partnerships to further the work in population health chronic condition management which align with IEHP organizational strategies (as well as regulatory and accreditation requirements from DHCS, NCQA, DMHC, and Covered CA) and drives health promotion, prevention and education.

Major Functions (Duties and Responsibilities) Cont

11. Serve as a resource to other Team Members to inform tactics to further outreach and recruitment of Members across all populations to engage in preventive or chronic condition care.

12. Collect Member level data either class participation, focus group and survey, with accuracy and collaborates with internal teams to support overall evaluation of program efficacy, or for continuous improvement.

13. Responsible to maintain electronic medical record system to document necessary notes and grow and maintain caseload of Members to support Population Health Management (PHM), chronic condition KPI and goals.

14. Partner with other IEHP field teams, to provide seamless care coordination and resource navigation to support the Member’s Plan of Care.

15. Perform other duties as assigned, within the scope of clinical health education to support IEHP strategic initiatives.

Experience Qualifications

A minimum of five (5) years of experience in clinical healthcare including but not limited to experience in hospital, utilization management and/or provider liaison duties, education, program planning, and evaluation. Must have experience delivering clinical health education in managed care, outpatient or community setting and demonstrated experience in care coordination in a clinical multi-disciplinary model. Must have experience in electronic medical record documentation and be able to navigate/escalate care when clinical risk is identified. Has knowledge or experience with underserved communities and understands health literacy, social determinants of health, and cultural barriers.

Education Qualifications

Bachelor's degree in any Science or Health Related field from an accredited institution required.

Professional Certification

Health Coaching certificate from a nationally recognized certificate program is preferred.

Public Health Nurse Certification (PHN) preferred.

Professional certification(s) highly preferred. Specialized certification is highly preferred, to address special populations with chronic conditions (diabetes, asthma, depression, cardiovascular disease) such as Certified Diabetes Educator (CDE), Certified Asthma Educator (ACE), Perinatal nursing certification (RN-BC), or Certified Childbirth Educator (ICCE).

Professional Licenses

Possession of an active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California State Board of Nursing required.

Skills Requirement

- Bilingual (English/Spanish) preferred.

- Excellent interpersonal and communication skills. Strong organizational skills. Strong discernment skills in challenging situations

- Highly skilled interpersonally with excellent relationship skills. Highly skilled in interpersonal communication, including resolving conflict.

Working Conditions

May require some evening and weekend shifts.

Position is eligible for telecommuting/remote work location upon completing the necessary steps and receiving HR approval. All IEHP positions approved for telecommute or hybrid work locations may periodically be required to report to IEHP’s main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership.

Work Model Location

Telecommute

A reasonable salary expectation is between $91,000.00 and $116,022.40, based upon experience and internal equity.