RN Clinic Health Coach

3 days ago Be among the first 25 applicants

At Nebraska Methodist Health System, we focus on providing exceptional care to the communities we serve and the people we employ. We call it The Meaning of Care – a culture that has and will continue to set us apart. It’s helping families grow by making each delivery special, conveying a difficult diagnosis with a compassionate touch, going above and beyond for a patient’s needs, or giving a high five when a patient beats a disease or conquers a personal health challenge.

We offer competitive pay, excellent benefits and a great work environment where all employees are valued. Most importantly, our employees are part of a team that makes a real difference in the communities we live and work in.

Location:

Methodist Physicians Clinic - Millard

Address: 5908 S. 142nd Street - Omaha, NE

Work Schedule:

Monday through Friday, 8am - 4:30pm

The Health Coach directly supports and promotes the care transitions and social support needs of patients across the continuum of care. The position also supports quality and improvement initiatives through targeted outreach to patients who are not meeting clinical goals. The Health Coach collaborates with providers, care managers, social workers, and others to facilitate seamless transitions of care, social support interventions, and patient engagement to close care gaps with the goal of assuring superior patient experience and quality outcomes.

• Navigates high‑risk patients across the continuum.
• Serves as main point of contact for patients and providers across care settings.
• Aims to better manage patients in ambulatory settings and reduce acute care and ED use.
• Develops patient care plans with interventions and goals appropriate to patient needs.
• Works collaboratively with internal and external entities to facilitate seamless transitions of care across the continuum by adhering to clinic standards.
• Initiates and completes the transition of care (TOC) process at time of patient discharge.
• Coordinates care with physicians and care team and documents care plans.
• Assists patients with psychosocial needs and helps patients access benefits and community resources.
• Connects patients using the ED for non‑acute needs with primary care, non‑clinical assistance, and promotes right site utilization.
• Provides self‑management support and may offer disease‑specific guidance (e.g., Diabetes, CHF, COPD, Pneumonia).
• Manages patients' discharges from inpatient facilities and ED, providing outreach including medication reconciliation and ongoing follow‑up as needed.
• Utilizes motivational interviewing skills to promote patient engagement and activation.
• Establishes rapport; assesses readiness, conviction, motivation, and confidence; helps patients identify problems, solutions, next actions, and follow‑up.
• Works with patients and families on self‑management and sets goals for improving health.
• Creates a plan for change by identifying barriers and a plan to overcome them.
• Coordinates care across the care continuum, coordinates office care team, and collaborates with providers to communicate lab and other test results.
• Uses professional nursing processes to assess the needs of patients and families calling or presenting for care in the physician office.
• Acts as liaison with specialty care offices and links to community resources.
• Involves in quality improvement (QI) activities and initiates improvement projects.
• Meets bimonthly with other Health Coaches to share best clinic practices and successes.
• Coordinates completion of payer gap lists and manages diabetic quality measures.
• Provides appropriate age‑specific care to ensure understanding and comfort level of treatment.

Work Schedule:

Monday through Friday, 8am - 4:30pm

• Successful completion of annual mandatory education requirements.
• Graduated from an accredited school of nursing required, Associate of Science in Nursing (ASN).
• Bachelor of Science in Nursing (BSN) preferred.

• Minimum 1-3 years of patient care experience required.

• Current valid Registered Nurse (RN) license, valid compact…