Population Health Float Nurse, NC

4506 Title: Population Health Float Nurse Department: Population Health and Case Management Status: Hourly Location: Remote Reports To: Population Health and Case Management Manager Direct Reports: None Travel: Less than 20% Summary of Position Under the direct supervision of the Population Health Manager, the Population Health Float Nurse works collaboratively with providers, clinical support staff, and other healthcare professionals to deliver a medical home model and optimize care using a team-based approach. This role is integral to the care team and is responsible for prioritizing daily interventions based on required services for patients on provider panels. The nurse engages patients and families dealing with chronic diseases and complex medical conditions, helping them develop individualized goals to enhance self-management. Responsibilities include chronic care management, care plan development, care coordination, and connecting patients to internal and community resources. The nurse will communicate extensively with interdisciplinary team members within the organization and with external community and contractual partners. Work will be guided by established quality benchmarks and clinical practices, including but not limited to Uniform Data System (UDS), Patient-Centered Medical Home (PCMH), and Healthcare Effectiveness Data and Information Set (HEDIS). Minimum Qualifications • Skills: • Excellent verbal communication • Ability to adapt to changing priorities • Strong organizational, problem-solving, and critical thinking skills • Proficiency in Microsoft Office Suite • Understanding of quality improvement (QI) methodologies • Proficiency in EMR documentation and electronic chart review • Experience: • Minimum of three (3) years in a public health or ambulatory care setting • Education: • Licensed Practical Nurse (LPN) or Registered Nurse (RN) • Licensure/Certification: • Unrestricted license in the state of North Carolina (if applicable) • Current BLS certification Key Responsibilities • Conduct pre-visit panel assessments to support care team communication and service delivery during scheduled encounters (e.g., huddles, pre-visit planning, recalls, follow-ups) • Monitor daily patient schedules to assess availability and triage walk-ins • Provide telephonic triage during business hours and patient education using evidence-based criteria within scope of practice • Coordinate quality improvement strategies under the direction of the Practice Manager and QI Champion, in collaboration with the Kintegra Health QI Department • Maintain detailed knowledge of provider roles, support staff functions, and EMR documentation standards to analyze clinical quality reports • Educate new patients on the Medical Home model, Patient Portal, Kintegra Health ancillary services, and the team-based care approach • Serve as a liaison between patients, clinical teams, operations, patient services, and customer care departments • Support medication adherence in collaboration with the Kintegra Pharmacy Team • Complete Health Risk Assessments • Provide Chronic Care Management services, including telephonic outreach and care plan development to support disease management goals • Communicate effectively with providers, interdisciplinary team members, community resources, and contracted partners • Document all care management activities clearly and concisely in the electronic medical record • Attend departmental meetings at assigned sites • Perform other duties as assigned Kintegra Health Core Requirements • Patient First – Prioritizing the well-being and preferences of the patient • Build Not Blame – Focusing on process improvement rather than assigning personal fault • Integrity and Honesty – Promoting openness, fairness, and responsible use of resources • Cooperation and Flexibility – Functioning as part of an interdependent team, committed to supporting beyond job descriptions • Cultural Sensitivity – Continuously improving the ability to understand, communicate with, and care for people across cultures About Kintegra Health Kintegra Health is a community-sponsored, family-centered provider of healthcare, health education, and preventive services, regardless of the ability to pay. We seek employees who align with our core values and are committed to our mission of serving the growing communities around us. Our Goals • Provide comprehensive and accessible primary care to individuals and families of all economic levels • Address both physical and social health needs through timely diagnostics, treatment, and referrals • Emphasize preventive care through patient and community education • Employ an interdisciplinary team approach in collaboration with community providers to deliver cost-effective, patient- and family-centered care