Clinical nurse educator | Ontario, CA

Clinical Nurse Educator will exist within an infrastructure of a care coordination model, to assist in engaging Members into the right level of care and will collaborate with others in the health education, promotion & prevention team (as well as other internal IEHP teams) to facilitate regional strategy and community partnerships to drive collective impact.

The Clinical Nurse Educator will work with the underserved and vulnerable population to provide health education in a culturally tailored way that engages Members to increase their readiness for behavior change and will serve to support a strategic multi-disciplinary team to drive improvement in regulatory HEDIS/MCAS performance care

gaps. Major Functions (Duties and Responsibilities) In partnership with other care management team(s) such as Enhanced Care Management, Complex Care Management, Transitions of Care, and/or shop Team, participate in the warm hand-off for the Member's Care Plan to support success in chronic condition self-management through the formulation of individualized wellness plans based on the backssment of members' medical condition, level of readiness and knowledge base, by utilizing various techniques that encourage and support behavioral, lifestyle changes and/or chronic condition education and goal setting.

Responsible for reviewing chart notes, electronic medical records, and/or relevant clinical

information focused on but not limited to medical management and disease processes within compliance turnaround times and quality standards meeting regulatory requirements as defined by Department of Health Care Services, Center for Medicare & Medicaid Services, California Department of Managed Health Care, and National Committee for Quality Assurance.

Perform clinical review of Member's medical history and provides education, training, and advocacy around care plan adherence, technical support/education for durable medication equipment, such as glucometer, self-monitoring blood pressure kit, asthma spacer, etc. medication administration, such as subcutaneous injections, and lifestyle change for activities/interventions focused on medical /chronic conditions driven to improve outcomes in Member HEDIS/MCAS care gaps.

Review and respond to interdepartmental tasks sent via MHK, Meditrac, Care Director, or any other systems that require to coordinate the care of the Member as necessary and with other departments such as shop, Member Services, Care Management/Behavioral Health, Compliance, and collaborate with those departments and teams to coordinate chronic condition care and close the referral loop with Member's Provider. Demonstrate effective documentation in Member Care Plan, and appropriate clinical care escalation when risk is identified and participate in case review conference with interdisciplinary teams, as needed to discuss ongoing needs of Members, which include, but not limited to disease progression and management review and consultation.

Maintain current and timely clinical knowledge around best practices for chronic condition management and attend seminars and trainings to learn about different disease states and evidence-based approaches to effective health management. Communicate with Providers and Members to provide information and assistance as appropriate and facilitate and coordinate follow-up with Provider, as necessary to support coordination of care and utilize Member engagement tools and styles to motivate, inspire, and shift Members to higher readiness for actions that support disease management and delay disease progression.

Partner with the Quality Teams to understand tiered risk populations and select opportunities for greatest impact surrounding health maintenance and delaying disease progression. Support overall IEHP and Departmental-level Strategic Goals related to disease management and progression and support regional strategies and priorities and collaborate with organizational priorities driven to address health disparities and inequities.

Foster and maintain strategic partnerships to further the work in population health chronic condition management which align with IEHP organizational strategies (as well as regulatory and accreditation requirements from DHCS, NCQA, DMHC, and Covered CA) and drives health promotion, prevention and education. Major Functions (Duties and Responsibilities) Cont 11. Serve as a resource to other Team Members to inform tactics to further outreach and recruitment of Members across all populations to engage in preventive or chronic condition care.

12. Collect Member level data either class participation, focus group and survey, with accuracy and collaborates with internal teams to support overall evaluation of program efficacy, or for continuous improvement. 13. Responsible to maintain electronic medical record system to document necessary notes and grow and maintain caseload of Members to support Population Health Management (PHM), chronic condition KPI and goals. 14. Partner with other IEHP field teams, to provide seamless care coordination and resource navigation to support the Member's Plan of Care.

15. Perform other duties as assigned, within the scope of clinical health education to support IEHP strategic initiatives. Supervisory Responsibilities Leading: Self Experience Qualifications A minimum of five (5) years of experience in clinical healthcare including but not limited to experience in hospital, utilization management and/or provider liaison duties, education, program planning, and evaluation. Must have experience delivering clinical health education in managed care, outpatient or community setting and demonstrated experience in care coordination in a clinical multi-disciplinary model.

Must have experience in electronic medical record documentation and be able to navigate/escalate care when clinical risk is identified. Has knowledge or experience with underserved communities and understands health literacy, social determinants of health, and cultural barriers. Education Qualifications Bachelor's degree in any Science or Health Related field from an accredited institution required. Preferred Education Master's degree from an accredited institution preferred. Professional Certification Health Coaching certificate from a nationally recognized certificate program is preferred.

Public Health Nurse Certification (PHN) preferred. Professional certification(s) highly preferred. Specialized certification is highly preferred, to address special populations with chronic conditions (diabetes, asthma, depression, cardiovascular disease) such as Certified Diabetes Educator (CDE), Certified Asthma Educator (ACE), Perinatal nursing certification (RN-BC), or Certified Childbirth Educator (ICCE). Professional Licenses Possession of an active, unrestricted, and unencumbered Registered Nurse (RN) license issued by the California State Board of Nursing required.

Drivers License Required Yes, must have a valid California Driver's License. Knowledge Requirement Possess subject matter expertise around the following areas, including but not limited to: Discipline of health education such as chronic condition prevention, nutrition, behavioral health, and knowledge working across the lifecycle (including the perinatal journey). Clinical manifestation of chronic conditions, pregnancy, and risk identification, management/mitigation, and care coordination. Understand cultural linguistic barriers to serving disparate populations such as for birth equity, justice involved.

Managed care and regulatory/accreditation experience is a plus. Navigating across multi-disciplinary care teams. Electronic medical documentation in Member Care Plan. Adult learning theories. Skills Requirement Bilingual (English/Spanish) preferred. Excellent interpersonal and communication skills. Strong organizational skills. Strong discernment skills in challenging situations Highly skilled interpersonally with excellent relationship skills. Highly skilled in interpersonal communication, including resolving conflict. Abilities Requirement Proven ability to: Work independently and collaboratively.

Deliver education in a culturally sensitive manner, and build trust, and strong rapport with Member. Work effectively in cross-functional team. Commitment to Team Culture The IEHP Team environment requires a Team Member to participate in the IEHP Team Culture. A Team Member demonstrates support of the Culture by developing professional and effective working relationships that include elements of respect and cooperation with Team Members, Members and associates outside of our organization. Working Conditions May require some evening and weekend shifts.

Position is eligible for telecommuting/remote work location upon completing the necessary steps and receiving HR approval. All IEHP positions approved for telecommute or hybrid work locations may periodically be required to report to IEHP's main campus for mandatory in-person meetings or for other business needs as determined by IEHP leadership. Work Model Location Telecommute Physical Requirements Keyboarding: 10-Key - FREQUENTLY Keyboarding: Touch-Screen - FREQUENTLY Keyboarding: Traditional - FREQUENTLY Hearing: One-on-One - FREQUENTLY Communicate: Information/ideas verbally - FREQUENTLY Near Visual Acuity - FREQUENTLY Sitting - CONSTANTLY Indoors - FREQUENTLY Lighting - CONSTANTLY Regular contacts: co-workers, supervisor - FREQUENTLY Memory - FREQUENTLY Understand and follow direction - FREQUENTLY Regular and reliable attendance - CONSTANTLY A reasonable salary expectation is between $91,000.00 and $116,022.40, based upon experience and internal equity.

Inland Empire Health Plan (IEHP) is the largest not-for-profit Medi-Cal and Medicare health plan in the Inland Empire. We are also one of the largest employers in the region, designated as " Great Place to Work.

" With a provider network of more than 5,000 and a team of more than 3,000 employees, IEHP provides quality, accessible healthcare services to more than 1.5 million members. And our Mission, Vision, and Values help guide us in the development of innovative programs and the creation of an award-winning workplace. As the healthcare landscape is transformed, we're ready to make a difference today and in the years to come. Join our Team and make a difference with us! IEHP offers a competitive salary and stellar benefit package with a value estimated at 35% of the annual salary, including medical, dental, vision, team bonus, and state pension plan.

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