Mid-State Health Center seeks a full-time registered nurse to join our team. The successful candidate will be a team-player while serving in a key role on our care team. This position is responsible for providng professional nursing care for MSHC patients and families established standards and practices. Assists clinicians and staff in coordinating patient care.

ESSENTIAL FUNCTIONS:

1. Adheres to established MSHC policies and procedures.

2. Works within the RN Scope of Practice. Maintains current New Hampshire license and required continuing education credits. Maintains skills by completing all required clinical competencies and training at orientation, annually, and as needed for new equipment or procedures.

3. Collaborates with clinicians and other care team members.

4. Incorporates Medical Home model of care into daily practice.

5. Provides patient education. Assists with patient follow up calls and medication reconciliation.

6. Communicates and collaborates with external agencies such as Speare Memorial Hospital and Home Health agencies.

7. Performs other duties including Continuous Quality Improvement (CQI) as requested or assigned.

8. Adherence to current evidence-based clinical guidelines, standards of care, and standards of practice, as applicable

9. Enrolling patients, per CMS Guidelines, to the CCM program.

10. Conducting telephonic wellness check-ins on the patients of your assigned practice or practices. You will spend 6-8 hours a day on the phone with patients, practices, pharmacies, etc. to ensure that your patients are getting what they need between office visits.

11. Creating a personalized care plan for each patient you call on, in coordination with the practices and providers you support.

12. Working to identify social determinants of health, gaps in care, and eligibility for assistance or other referral services for each of your patients. You will coordinate and collaborate with the practices’ providers, clinical and office staff, and other community programs and resources to address all of these effectively.

13. Utilizing motivational interviewing and solution-oriented approaches to empower patients to take charge of their own wellness in the context of their care plan.

14. Making approximately 30-50 phone calls a day to yield the 12-16 patient interactions necessary to complete 20 minutes of CCM service for 10-14 patients a day.

15. Do all of the above while maintaining your patients’ privacy, confidentiality and safety, and adhering to ethical, legal, and accreditation/regulatory standards at all times.

16. Process referrals, orders and medication refills per protocol.

17. Care Transitions from inpatient facilities.

Requires an active, unencumbered RN license (BSN preferred) and current BLS certification.

Nurses must be able to work in both our Plymouth and Bristol offices as needed.

If interested in becoming part of our Health Care Team please forward a cover letter and resume to:

Carolyn Varin, RN
Director of Clinical Support

Mid-State Health Center
101 Boulder Point Drive
Plymouth, NH 03264

Mid-State Health Center complies with applicable Federal civil rights laws and does not discriminate on the basis of color, race, national origin, age, disability, or sex.

Job Type: Full-time

Pay: $27.50-35.00 per hour

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