RN, Medical Group | Primary Care | Full Time Days

Overview

The Registered Nurse provides comprehensive clinical support for ambulatory patients through nursing assessment, telephone triage, Epic In-Basket and telephone encounter management, chronic disease management, and care coordination. Responsibilities include evaluating patient concerns, coordinating follow-up care and Transitional Care Management activities, supporting medication management, providing patient education, and promoting preventative care and quality improvement initiatives. The RN collaborates closely with providers, Medical Assistants, and interdisciplinary healthcare teams to ensure timely clinical communication, continuity of care, patient safety, and optimal patient outcomes while practicing within the scope of professional nursing standards.

Responsibilities

• Clinical Triage and Patient Assessment
• Perform nursing assessments and evaluate patient concerns within the scope of RN practice.
• Manage clinical telephone encounters and patient messages, utilizing established protocols to determine appropriate patient disposition.
• Prioritize patient needs, identify urgent or emergent concerns, and initiate appropriate clinical escalation.
• Communicate significant assessment findings and changes in patient condition to providers.
• Coordinate appropriate appointments, follow-up care, and patient education based on clinical needs.
• Epic In-Basket and Telephone Encounter Management
• Monitor and manage assigned Epic In-Basket messages and telephone encounters, ensuring timely and appropriate resolution.
• Prioritize clinical communications based on urgency, patient safety, and established workflows.
• Coordinate medication-related inquiries, prescription clarifications, and provider communications.
• Route encounters requiring provider evaluation or medical decision-making to the appropriate clinical personnel.
• Track outstanding requests and ensure appropriate follow-up and accurate documentation in the electronic health record.
• Chronic Disease Management and Patient Education
• Support the ongoing management of patients with chronic conditions, including diabetes, hypertension, congestive heart failure, and COPD.
• Reinforce provider-established treatment plans, medication adherence, and recommended lifestyle modifications.
• Identify patients with uncontrolled chronic conditions or gaps in care requiring additional clinical intervention.
• Coordinate laboratory monitoring, diagnostic testing, and follow-up appointments.
• Educate patients on disease management and collaborate with the healthcare team to address barriers to care.
• Care Coordination and Transitional Care Management
• Collaborate with providers and interdisciplinary care teams to promote continuity of care across healthcare settings.
• Support Transitional Care Management (TCM) activities, including post-discharge outreach, nursing assessments, and follow-up coordination.
• Review hospital discharge information, reinforce discharge instructions, and identify ongoing patient care needs.
• Assist with medication reconciliation, identification of discrepancies, and communication of medication changes.
• Coordinate timely post-discharge appointments and facilitate communication with specialists, hospitals, home health agencies, and community resources.
• Identify patients at increased risk for hospital readmission and support interventions to reduce avoidable emergency department visits and hospitalizations.
• Quality Improvement and Preventative Care
• Support organizational quality initiatives, including applicable MIPS measures and preventative care programs.
• Identify gaps in preventative care and coordinate appropriate patient outreach and follow-up.
• Monitor and facilitate follow-up of abnormal screening results and diagnostic findings.
• Promote accurate clinical documentation and adherence to established Epic workflows.
• Collaborate with providers and Medical Assistants to improve quality measures, screening compliance, and patient outcomes.
• Participate in quality reviews, performance improvement initiatives, and clinical education activities.
• Provider and Clinical Team Support
• Serve as a clinical resource to Medical Assistants and other clinic personnel regarding nursing workflows, patient care, and clinical escalation.
• Assist providers with complex patient care needs and nursing interventions.
• Collaborate with practice leadership to identify opportunities to improve clinical processes, efficiency, and patient safety.
• Participate in interdisciplinary meetings, clinical huddles, and staff education.
• Promote effective communication, teamwork, and accountability across the clinical team.
• Medication Management and Nursing Interventions
• Assess medication-related concerns, identify potential adverse reactions, and communicate findings to providers.
• Assist with medication reconciliation and resolution of identified discrepancies.
• Process prescription refill requests in accordance with established clinical protocols and organizational policies.
• Administer prescribed medications, injections, and nursing treatments within scope of practice.
• Provide patient education regarding medications, treatment plans, and prescribed interventions.
• Maintain accurate documentation of medication administration and nursing procedures.
• Patient Safety, Regulatory Compliance, and Professional Standards
• Practice in accordance with the Florida Nurse Practice Act, professional nursing standards, and UF Health policies and procedures.
• Maintain compliance with HIPAA and organizational requirements for patient confidentiality and information security.
• Identify, document, and appropriately escalate patient safety concerns.
• Participate in infection prevention, emergency preparedness, and quality assurance activities.
• Maintain current professional licensure and required clinical competencies.
• Demonstrate professionalism, accountability, and a commitment to patient-centered care.

Qualifications

Education

Associates Degree

Licensure/Certification/Registration

Florida Registered Nurse License

BLS

Special Skills/Qualifications/Additional Training/Experience Required

• Strong clinical assessment, critical thinking, and independent nursing judgment skills.
• Demonstrated ability to perform telephone triage and prioritize patient care based on clinical urgency.
• Proficiency in electronic health records, preferably Epic, including In-Basket management and clinical documentation.
• Knowledge of ambulatory nursing practices, chronic disease management, and preventative care.
• Experience with Transitional Care Management (TCM), hospital discharge follow-up, and care coordination preferred.
• Knowledge of medication management, medication reconciliation, and prescription refill processes.
• Strong patient education, communication, and organizational skills.
• Ability to manage multiple priorities and work independently in a fast-paced clinical environment.
• Commitment to patient safety, confidentiality, and quality patient care.

Education

Associates Degree