Community Health Nurse
Full Time
Hourly
$30 - 33/hour
This position is responsible for assisting Native American Community Clinic (NACC) Community Health Department preventative care and chronic disease management grant programming and quality improvement projects through patient outreach and education.
ESSENTIAL DUTIES AND RESPONSIBILITIES:
Phone and mail outreach for population health management. Includes scheduling appointments and basic care coordination.
Generate population health reports for various preventative health and chronic disease management initiatives
Educate patients on timeline for preventative care screening and follow up including cancer screening, diabetes, cardiovascular disease, well child checks, asthma management and others.
Recruit for chronic disease management groups and preventative care events and programming.
Field Community Health Department referrals including diabetes education, diabetes prevention program, mobile medical services (mammogram and vision), asthma management, and colorectal cancer screening fit kit referrals.
Support grant specific program evaluation activities and incorporating findings to refine and improve program effectiveness to meet grant deliverables
Track attendance and reach required for each grant
Complete monthly reports for program and grant activities provided to Community Health Manager.
Assist with grant reporting as requested by Community Health Manager Core duties and responsibilities include the following.
Assist with the programs in purchasing and budget maintenance.
Work with grant/project evaluators and Community Health Manager to develop data and reports as required to fulfill requirements of program evaluation plans.
Maintain regular communication with project partners and with the project officer to fulfill grant requirements, including submitting regular reports, as required.
Support ongoing sustainability planning on behalf of Community Health Programs.
Play an active role on the outreach team. Other duties may be assigned.
GRANTS:
MINNESOTA DEPARMENT OF HEALTH (MDH): SAGE SCOPES GRANT & MINNESOTA CANCER CLINICAL TRIALS NETWORK: COLOCRECTAL CANCER SCREENING GRANT
Assist with identifying eligible patients for colorectal cancer screening outreach
Deliver colorectal cancer screening promotion and education for eligible patients through mailings and phone calls
Provide fit kit education and follow up for eligible patients
Complete MDH Sage Scopes enrollment forms and tracking for eligible patients seeking colorectal cancer screening
MINNESOTA DEPARTMENT OF HEALTH (MDH): ASTHMA GRANT
Conduct outreach to patients with asthma with elevated Asthma Control Test (ACT)
Administer an asthma control test via phone outreach for those with elevated and past due ACT
Provide education to each patient or that patient’s caregiver on how to use the Asthma Action Plan to guide asthma management.
Provide education on reducing home-based allergens and referring to home visiting asthma programs.
Complete spirometry for asthma patients
GREAT LAKES INTERTRIBAL EPIDEMIOLOGY CENTER (GLITEC) GOOD HEALTH AND WELLNESS IN INDIAN COUNTRY GRANT:
Increasing awareness of prediabetes among tribal members and health care providers/ health professionals
education and awareness of chronic disease prevention and management at urban Native American community events
engagement of current patients in regular screening of chronic diseases including diabetes
engagement of current patients in lifestyle support for diabetes prevention and prediabetes
clinical services to support prevention, detection, and control of high blood pressure and/or high blood cholesterol.
referral and engagement in culturally specific chronic disease prevention education and production.
Direct delivery of patient education and support
Increased patient engagement with at home monitoring, improved control measures
SUPERVISORY RESPONSIBILITIES:
This job has no supervisory responsibilities.