Description: WESTSIDE IS LOOKING FOR NURSES! $5,000 SIGN ON BONUS! LOAN REPAYMENT PROGRAM AVAILABLE! JOIN A CARING, DEDICATED NURSING TEAM MAKING A DIFFERENCE IN OUR COMMUNITIES! Westside Family Healthcare is a nonprofit organization that provides high quality primary medical care without regard to ability to pay. The Ambulatory Care Nurse (RN) is an on-site nurse RN serving as an integral member of the patient care team, supporting assigned care teams by managing high and rising risk patients, coordination services throughout the continuum of care and serves as the in-office nurse. The Ambulatory Care Nurse RN supports patients by facilitating implementation of the prescribed medical treatment plan through patient-centered education of disease processes and wellness opportunities and through patient self-management skill development. WORKING AT WESTSIDE MEANS WORKING IN A PRIMARY CARE MEDICAL HOME. A Primary Care Medical Home is not a special building. It is a way to provide healthcare that puts the patient at the center of health care decision-making. OUR MISSION: To improve the health of our communities by providing equal access to quality healthcare, regardless of ability to pay. OUR BENEFITS : Our benefit package includes medical insurance, dental insurance, vision insurance, life and disability insurance, a 401(k) retirement plan with a match, and supplemental insurances. We offer a generous PTO package and flexibility to provide work/life balance. Westside Family Healthcare is an Equal Opportunity Employer that values diversity. RESPONSIBILITIES OF NURSES * Manage a caseload of patients identified as at risk for health deterioration, sentinel events and/or poor outcomes using the nursing process and established protocols/workflows. Ongoing evaluation of care coordination efforts by measuring interventions effectiveness and fostering a continuous improvement mentality. Partners with the patient and family, the primary care provider, and other team members to implement an interdisciplinary plan of care. * Participates in daily huddles with the Clinical Operations team, and other team meetings/trainings as scheduled * Proactively and continuously reviews patient medical records to identify any care needs requiring intervention or follow up during patient interactions * Works with patients and families to ensure both medical and psychosocial needs are met in order to promote health and well-being and to identify any barriers that inhibit the patient from adhering to the prescribed plan of care * Educates patient/family about medical conditions (existing or newly diagnosed) to assist them in appropriate self-management * Proactively incorporates lifestyle improvement opportunities and preventative care into patient interactions, empowering patients to reach their individual health goals * Assesses and documents progress towards goals based on provider's plan of care; utilizing clinical judgment, established protocols, review of patients' self-monitory tools and trends in clinical data (i.e., HbA1c, LDL, BP) * Promotes timely access to appropriate care, increasing the utilization of preventative care and healthy behaviors to improve the health of the population at risk * Provides ambulatory care support as a member of the care team, which may include, but is not limited to walk-in and/or telephone triage utilizing established protocols * Proactively advocates for patient care issues to ensure overall quality and adherence to provider's plan of care; ensuring care is sensitive to each specific patient's needs * Participates in quality improvement activities and initiatives. Other duties as assigned. * Maintains compliance with all professional and organization requirements to meet position standards PM22 Requirements: MINIMUM OBJECTIVE QUALIFICATIONS * Graduate of an accredited nursing program with an associate degree in Nursing * Active RN licensure in the State of Delaware (or compact state) with no restrictions or disciplinary action * Current BLS certification * Active Ambulatory Care Certification (AMB-BC) - must commit to obtaining within 1 year of hire PIad70c264f1d3-29400-39571210