Job Description

PHMC serves as both a direct service provider to individuals, families, and communities across the region and as an intermediary agent — managing large-scale contracts, government and philanthropic partnerships, and multidisciplinary initiatives that require operational sophistication, strategic leadership, and deep mission alignment.

SUBSIDIARY: Health Services

DEPARTMENT: Health Connection Health Center

ROLE TYPE: Full-Time

Provide primary care to diverse, underserved patients at a community-based nurse-managed health center. The Nurse Care Manager will report to the Clinical Director.

Age/Patient Populations SERVED (Double-click on box to activate appropriate indicator)

Age of Patient Population Served
Neonate (birth - 28 days)

Infant (29 days – less than 1 year)

Pediatric (1 - 12 yrs)

Adolescent (13 – 17 yrs)

Adult (18 – 64 yrs)

Geriatric (65 yrs & older)

Nonage Specific Task (N/A)

Population
BMI greater than 40, or greater than 35 with weight-related comorbidities

Patient with exceptional communication needs

Patient with developmental delays

Patient at the end of life

Patient under isolation precautions

All Populations

Essential Duties and Responsibilities:

• Provides patient assessments, health education, health screenings, immunizations, and other disease prevention programs.
• Serves as care manager for patients with chronic health problems, high utilization patients, and high-risk patients.
• Assists with improving process and outcome measures toward continuous quality improvement.
• Assists with medication refills.
• Accurately records care provided and completes other assigned reports.
• Participates in interdisciplinary team meetings, including creating agenda documentation.
• Works within all state and federal laws and regulations.
• Notifies the immediate supervisor of significant problems.
• Maintains positive relationships with funding sources and community organizations
• Champion of shared decision making.
• Performs other tasks as directed and needed, including triaging of patients and linguistic services.
• Initiates opportunities to practice to the full extent of their education and training.
• Serves as a full partner of the health care team by assessing, analyzing, and addressing the chronic care needs of complex patients.

PHMC Compliance Responsibilities:

• Understands and adheres to PHMC compliance standards as they appear in the PHMC Code of Conduct, Whistleblowers, and Conflict of Interest Policies.
• Keeps abreast of all pertinent federal, state, and PHMC regulations, laws, and policies as they presently exist and as they change or are modified.
• Comply with HIPAA and Confidentiality Policies and Procedures as they apply to the job.
• Comply with Department of Public Health (DPH), The Joint Commission, and other accreditation and regulatory agencies' standards.
• Adhere to all PHMC Policies and Procedures.
• Knowledge and adherence to Infection Control and Environment of Care Guidelines and Procedures as described in the annual education module.

Job Requirements

To perform this job successfully, an individual must satisfactorily perform each essential duty. The requirements listed below must be representative of the knowledge, skills, minimum education, training, licensure, experience, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Skills:

• Strong written and verbal communication skills
• Ability to work with diverse staff in an urban setting
• Current CPR certification
• Ability to maintain comprehensive, accurate, and timely nursing documentation

EXPERIENCE:

• One year of experience in ambulatory care, community health, and/or behavioral health, socioeconomic, cultural, ethnic, and diversity required.
• Experience with or desire to work with the homeless or other populations with limited access to health care preferred.
• Care of case management experience.
• Evidence of sound clinical decision-making.

EDUCATION:

• Pennsylvania LPN License Required

PHMC is an Equal Opportunity and E-Verify Employer.