Registered Nurse - Population Health - Evernorth

Overview

Evernorth Workplace Care is dedicated to improving the health and well-being of our patients. We are seeking a passionate and independent Registered Nurse to join our team as a Population Health RN. This role focuses on proactive, patient-centered care, leveraging data-driven insights to address the needs of high-risk individuals.
Job Summary

Under the direction of a Licensed Physician and Clinical Director, the population health nurse will utilize their expertise and strong interpersonal skills to provide nursing care, and care coordination to a targeted patient population identified through risk stratification reports. This role involves comprehensive patient health risk assessments, health education, and benefits navigation, requiring a self-directed and highly motivated individual who can thrive in an independent setting.

Major Duties : Include but are not limited to the following.
Client Consultation & Strategic Reporting:

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Present population health findings, trends, and recommendations to client leadership and matrix partners, as appropriate

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Participate in client meetings to review outcomes, intervention performance, and emerging health priorities, as appropriate

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Partner with client stakeholders to prioritize population health initiatives and engagement strategies, as appropriate

Care Management:

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Performs comprehensive biometric health risk assessments and education, as appropriate

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Follow established nursing protocols and procedures

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Monitor medication compliance and provide patient education

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Provide patient education on chronic conditions, focusing on abnormal biometric values, health needs, and related behavioral lifestyle modifications

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Utilize motivational interviewing techniques to promote sustainable behavior changes, including diet, exercise and stress management

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Identify customer health education needs through targeted health assessment activities

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Identify and facilitate overcoming psychosocial barriers to care

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Collaborate with patients to establish health improvement plans, set personalized evidence-based health goals, and support patients in achieving those goals

- Track and monitor screening compliance

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Facilitate and promote preventive health screenings, including cancer screenings

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Lead and support a variety of Health and wellness promotional activities, such as group coaching, wellness challenges and Health related seminars Wellness campaigns at client’s location

CARE COORDINATION:

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Facilitate communication and coordination with external providers, including primary care, specialists

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Coordinate with community providers and resources to address patients’ needs and care gaps

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Reinforce provider’s care plans and ensure adherence

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Follow-up with patients regarding after-hours care recommendations

BENEFITS NAVIGATION:

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Referral to clinical programs and services

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Assist patients in navigating their benefits and accessing necessary resources

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Advocate for patients to ensure they receive timely and appropriate care

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Provide support for health-related site events, which include open enrollment, wellness committee facilitation, flu shot events, health fairs, etc.

ANALYTICS:

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Work from reports and dashboards that identify the highest-risk patients, proactively engaging them in care management activities

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Prioritized patient outreach and interventions based on risk stratification

ADMINISTRATIVE:

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Assures compliance with regulatory requirements regarding services

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Appropriate electronic documentation, in accordance with current policies and procedures

Qualifications:

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RN with current unrestricted compact state licensure required with three or more years of clinical practice experience

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Bachelor's degree in a health-related field. Master’s degree preferred.

- Current BLS/CPR/AED Certification

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Excellent Computer skills [specific software e.g. Word and Excel]

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Excellent interpersonal skills. Mus