Job Description

JOIN A CARING, DEDICATED NURSING TEAM MAKING A DIFFERENCE IN OUR COMMUNITIES! Westside Family Healthcare is a nonprofit organization that provides high quality primary medical care without regard to ability to pay. The Ambulatory Care Nurse (RN) is an on‑site nurse serving as an integral member of the patient care team, supporting assigned care teams by managing high‑risk patients, coordinating services throughout the continuum of care, and serving as the in‑office nurse. The RN facilitates implementation of the prescribed medical treatment plan through patient‑centered education of disease processes, wellness opportunities, and patient self‑management skill development. WORKING AT WESTSIDE MEANS WORKING IN A PRIMARY CARE MEDICAL HOME. A Primary Care Medical Home is not a special building; it is a way to provide health care that puts the patient at the center of decision‑making. OUR MISSION: To improve the health of our communities by providing equal access to quality healthcare, regardless of ability to pay. OUR BENEFITS: Medical insurance, dental insurance, vision insurance, life and disability insurance, a 401(k) retirement plan with match, and supplemental insurances. Also a generous PTO package and flexible work/life balance. Westside Family Healthcare is an Equal Opportunity Employer that values diversity. RESPONSIBILITIES: Manage a caseload of patients identified as at risk for health deterioration, sentinel events, and/or poor outcomes using the nursing process and established protocols/workflows. Ongoing evaluation of care coordination efforts by measuring intervention effectiveness and fostering a continuous improvement mentality. Partner with the patient and family, the primary care provider, and other team members to implement an interdisciplinary plan of care. Participate in daily huddles with the Clinical Operations team, and other team meetings/trainings as scheduled. Proactively and continuously review patient medical records to identify care needs requiring intervention or follow‑up during patient interactions. Work with patients and families to ensure both medical and psychosocial needs are met to promote health and well‑being and to identify barriers that inhibit adherence to the prescribed plan of care. Educate patient/family about medical conditions to assist them in appropriate self‑management. Proactively incorporate lifestyle improvement opportunities and preventative care into patient interactions, empowering patients to reach their individual health goals. Assess and document progress toward goals based on provider’s plan of care; utilize clinical judgment, established protocols, review of patient self‑monitoring tools and trends in clinical data (e.g., HbA1c, LDL, BP). Promote timely access to appropriate care, increasing utilization of preventative care and healthy behaviors to improve the health of populations at risk. Provide ambulatory care support as a member of the care team, including walk‑in and/or telephone triage using established protocols. Proactively advocate for patient care issues to ensure overall quality and adherence to the provider’s plan of care; ensure care is sensitive to each specific patient’s needs. Participate in quality improvement activities and initiatives; other duties as assigned. Maintain compliance with all professional and organizational requirements to meet position standards. REQUIREMENTS: Graduate of an accredited nursing program with an associate degree in Nursing. Active RN licensure in the State of Delaware (or compact state) with no restrictions or disciplinary action. Current BLS certification. Active Ambulatory Care Certification (AMB‑BC) – must commit to obtaining within 1 year of hire. #J-18808-Ljbffr

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