Join Martin's Point Health Care - an innovative, not-for-profit health care organization offering care and coverage to the people of Maine and beyond. As a joined force of "people caring for people," Martin's Point employees are on a mission to transform our health care system while creating a healthier community. Martin's Point employees enjoy an organizational culture of trust and respect, where our values - taking care of ourselves and others, continuous learning, helping each other, and having fun - are brought to life every day. Join us and find out for yourself why Martin's Point has been certified as a "Great Place to Work" since 2015.

Position Summary

NEW OPENING in New Hampshire! A Community Based Nurse at Martin's Point Health Care provides comprehensive, person-centered, longitudinal community based advanced care management (CM) interventions for members and families enrolled in the Complex Care Management Program.

Our nurses effectively engage, assess, monitor, educate, coordinate, and provide interventions for members and families to improve the quality of care and member health outcomes. This role reduces unnecessary health care utilization.

The nursing team collaborates with physicians, hospitals, skilled nursing facilities, home health providers and community services to advocate for member-centered goals and needs, to promote better health, and to prevent unnecessary hospital utilization.

If you are seeking a fulfilling position with face-to-face contact with patients in their homes, as well as telephonically...we would like to talk with you! We are seeking candidates who ideally reside in New Hampshire as travel is required to meet our patients throughout the state. Mileage reimbursement is offered for all travel. Don't wait...Apply today!

Job Description

Key Outcomes:

• Completes comprehensive advanced level nursing assessments for new and existing members, that include focused physical examinations, with attention to complex care and comorbidities.

• Incorporates a sophisticated knowledge of evidence-based, best practice standards of care for chronically ill members.

• Ensures i nitial member assessments, screenings, care transition assessments, encounters and follow-up are timely, complete, accurate, and according to established Care Management (CM) standards and protocols; and are documented in the case management medical record.

• Collaborates with the members’ primary care provider, specialists, and community service agencies, to address concerns from a participant member-centered perspective.

• Engages, assesses, and provides interventions and support to members, their families and caregivers to address medical, health, social, psychological, environmental and lifestyle issues; with the goal of improving health and preventing unnecessary hospital utilization.

• Documents all assessments, encounters, and other CBN activities in the case management medical record in a timely fashion.

• Ensures all written communication and member records and forms (both electronic and on paper), are complete, clear, well organized, legible, and professional (including proper grammar, spelling and include only approved abbreviations) and comply with MPHC CM standards.

• Demonstrates extraordinary teamwork skills that include flexibility, adaptability, and accountability, to meet the dynamic needs of the members and of the team and program, in a fast-paced learning environment.

• Develops and present case studies, participate in clinical rounds, in-services, and staff education and training.

• Demonstrates respect and excellent customer-service skills with all contacts. All aspects of conduct are respectful, professional, and ethical.

Education/Experience:

• Bachelor or Master of Science in Nursing preferred

• 10 years of current clinical experience, ideally in one or more of the following areas or specialty practice: medical-surgical, home care, hospice, community health, rehabilitation, long term care, cardiovascular, diabetes, and or pulmonary diseases, oncology, and geriatrics.

• Knowledge of Scope of Nursing Practice in states where licensed

Required License(s) and/or Certification(s):

• Unrestricted state licensed registered nurse license required: BSRN or MSRN preferred

• BLS Required

• Valid unrestricted driver’s license

We are an equal opportunity/affirmative action employer.

Do you have a question about careers at Martin’s Point Health Care? Contact us at: jobinquiries@martinspoint.org

Martin’s Point Health Care is a progressive, not-for-profit organization providing care and coverage to the people of Maine and beyond. The organization operates six primary care health care centers in Maine and New Hampshire, accepting most major insurance plans. Martin’s Point also administers two health plans: Generations Advantage (Medicare Advantage plans available throughout Maine and New Hampshire), and the US Family Health Plan (TRICARE Prime® plan for active-duty and retired military families in northern New England, upstate New York, and western Pennsylvania). For more information, visit https://careers.martinspoint.org .