The best thing about this role Are you looking to make a difference by improving the health of our patients? Here you will find an innovative culture that is patient-focused and dedicated to making a difference. We are committed to helping the population we serve, and our communities, achieve optimum health and enjoy the best quality of life possible. What you'll do Reporting to the Population Health department, the Wellness Nurse is responsible for a full range of services related to promotion of preventive and wellness plans, illness prevention, and chronic condition management of the patient population in order to improve health outcomes. The Wellness Nurse will complete screenings, comprehensive nursing assessments, close care gaps, and provide extensive patient education. Under the direct supervision of an onsite physician, the Wellness Nurse will perform the Medicare Annual Wellness Visit for Medicare Part B beneficiaries. An individualized plan of care will be developed with the patient focused on prevention and wellness goals, risk factor modification, chronic condition self-management skills and provide linkages to other supports and services as appropriate. The Wellness Nurse will demonstrate expertise in identifying patient risk factors and will collaborate with or refer to primary care clinicians, other practitioners, and ancillary services to address acute and ongoing patient needs. The Wellness Nurse acts as a resource for the Medicare patient population, primary care, population health and quality teams. Provides coordination of outreach and scheduling activities including verifying eligibility for Medicare Annual Wellness services Conducts Pre-Visit Planning activities to plan for efficient/effective patient visit Performs all aspects of Medicare Annual Wellness visits including screenings, assessments and plan of care in accordance with documentation requirements Promotes wellness and illness prevention using clinical nursing knowledge of disease process, risk factor identification and illness prevention strategies Provides education regarding lifestyle modifications, wellness promotion, illness prevention and chronic disease management within the context of the Annual Wellness visit to improve quality of care and patient outcomes Develops written, individualized prevention plan for each patient, including, but not limited to psychosocial/behavioral risk factors, physiological risk factors, age-appropriate preventive and health maintenance services, and care-gap closure Educates patients regarding advance care planning and additional community resources as identified Collaborates with physicians and other care team members to ensure patient receives referrals and follow up care as appropriate Ensures patients are scheduled for recommended services with input from PCP Maintains relevant nursing knowledge of evidence-based strategies related to health promotion, illness prevention and chronic condition management Educates patients/families/caregivers regarding disease processes, treatments, risk factor modification strategies, and prevention strategies as appropriate under the nurse's scope of licensure Maintains thorough knowledge of quality measures from PCMH, health plans, and The Joint Commission Ensures proper documentation in the EHR including closing data and care gaps as appropriate Performs nursing functions including, but not limited to, vital signs, immunizations, and collecting laboratory specimens Participates in the planning, and validation, and monitoring of regional KPI’s related to Medicare Annual Wellness Visit activities Maintains professional relationships with all internal and external colleagues Maintains confidentiality Performs other duties assigned What we need from you Education: 2 Year/Associate Degree In Nursing, required or... Vocational/Technical Diploma Professional Nursing Program, required or... 4 Year/Bachelor's Degree in Nursing, preferred ** All RN's hired and do not currently hold a BSN will be expected to demonstrate enrollment in a bachelor's prepared nursing program within 4 years of hire. BSN must be completed within 10 years. RN's licensed on or before 12/19/17 are/remain exempt from this requirement Experience: Minimum 3 years of relevant work experiences as an RN with experience working in a multi-disciplinary team, required Prior experience working with EPIC or other electronic medical record, preferred Licensure/Certifications: Current NYS licensure as a Registered Professional Nurse, required BLS (Basic Life Support) Certification, required Skills: Accountability Attention to Detail Build Relationships Communication Gathering/Extracting Information Computer Skills Creative Thinking Leadership Reading/Writing/Comprehension Self-Motivated Organizing/Categorizing Records Physical Requirements: Medium Work - Exerting up to 50 lbs. for force occasionally, and/or up to 20 lbs. of force frequently, and/or up to 10 lbs. of force constantly to move objects Occasional crouching, kneeling, lifting, pushing, reaching, stooping, walking Frequent typing/clerical/dexterity, grasping, hearing, repetitive motion, seeing/monitor/computer use, standing, talking, visual acuity (color, depth, perception) Constant fit testing Hazards: Occasional bodily fluids/bloodborne exposure Working Conditions: Occasional dust Travel: Occasional Travel - The job may require travel from time- to-time, but not on a regular basis Total Rewards Bassett Healthcare Network’s commitment to our employees includes benefit programs carefully designed with the needs and values of all our employees in mind. Many of the benefits we offer are paid fully or in large part by Bassett. Our generous benefits offerings include: Paid time off, including company holidays, vacation, and sick time Medical, dental and vision insurance Life insurance and disability protection Retirement benefits including an employer match And more! Specific benefit offerings may vary by location and/or position. Pay Transparency Salary is based on a variety of factors, including, but not limited to, qualifications, experience, education, licenses, specialty, training, and fair market evaluation based on industry standards. The above compensation range represents a good faith belief of the compensation range by Bassett Healthcare Network, and its entities and affiliates, at the time of this posting or advertisement. Pay Range Minimum: USD $84,409.51/Yr. Pay Range Maximum: USD $126,614.27/Yr. We love the difference people bring We provide equal employment opportunities (EEO) to all employees and applicants for employment without regard to race, color, religion, creed, sex (including pregnancy, childbirth, or related condition), age, national origin or ancestry, citizenship, disability, marital status, sexual orientation, gender identity or expression (including transgender status), genetic predisposition or carrier status, military or veteran status, familial status, status as a victim of domestic violence, or any other status protected by law.