Risk Stratification Nursing Specialist

Position Overview:

The Risk Stratification Nursing Specialist, as a member of the Clinical Team, is responsible for identifying, analyzing, and prioritizing individuals at increased risk for poor health outcomes, service gaps, or crisis needs. This role partners closely with Care Managers and the Clinical Team to ensure timely intervention and support, helping to stabilize high-risk individuals and improve overall care outcomes.

Essential Responsibilities:

Supports TCCs vision, mission, and values in all aspects of work. Holistically assesses individuals for risks associated with behavioral health, physical health, and social determinants of health (SDOH), per established processes. Completes detailed case reviews to determine level of need, risk status, and overall stability. Utilizes data from the electronic health record (EHR), health information technology (HIT) systems, and other relevant data sources to conduct ongoing risk stratification. Reviews and audit cases to evaluate the effectiveness of risk stratification processes. Collaborates with the Clinical Team to prioritize engagement, outreach, and intervention for clinically involved individuals. Supports quality improvement initiatives aimed at improving care coordination, stabilization, and outcomes for individuals. Ensures timely responses to all inquiries and requests, with a commitment to addressing and resolving issues within 24 hours to maintain efficient operations. Takes lead and ownership of assigned tasks and special projects within the teams and assist with coverage as needed. Maintains an up-to-date Outlook calendar to accurately reflect work-related meetings, appointments, and availability. Participates in internal and external meetings as needed. Performs other responsibilities, as assigned, to support overall organization's goals and objectives.

Specific Knowledge, Skills, and Abilities:

Ability to effectively engage and support individuals with behavioral health needs. Strong organizational skills with the ability to prioritize and complete tasks in timely manner. Demonstrates cultural competence and sensitivity to diverse populations. Demonstrates initiative and a proactive approach to professional responsibilities. Strong computer proficiency. Proficient in using Health Information Technology to support communication and care coordination. Knowledge of confidentiality requirements, including HIPAA regulations.

Experience:

Current RN licensure required. Minimum of 2 years of OPWDD experience preferred. Knowledge of developmental disabilities, chronic conditions, mental health, and social determinants of health. Familiarity with person-first, person-centered planning concepts. Experience with data analytics and interpreting data to inform care and decision making. This job description is not all inclusive and the employee may be asked to assume additional responsibilities as the need arises.

Benefits:

401K Retirement Plan & Employer Matching Health Insurance (Medical, Dental, Vision, Life & LTD) Employer Sponsored Flexible Spending Account (FSA) Generous Paid Time Off (PTO) Package, including birthday 9 legal holidays and 8 floating holidays Employee Assistance Program Travel Reimbursement Phone/Internet Reimbursement Company Provided Team Time