RN Registered Nurse - Women's Health

1 week ago Be among the first 25 applicants

This range is provided by HHM Health. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

$40.00/hr - $45.00/hr

The Integrated Internal Medicine Nurse provides high-quality, patient-centered nursing care in HHM Health’s Integrated Internal Medicine Department. This role is central to our integrated care model, ensuring that patients receive coordinated services across Internal Medicine, Behavioral Health, Pharmacy, Nutrition, Vision, Women’s Services, Psychiatry, and Dental care. The nurse collaborates closely with physicians, residents, advanced practice providers, Community Health Workers (CHWs), and the Health Operations team to deliver seamless, team-based care.

By combining clinical expertise with care navigation, this role helps patients achieve better outcomes and ensures alignment with HHM Health’s quality and performance goals.

• Provide direct outpatient patient care, including assessments, immunizations, medication administration, wound care, and health screenings.
• Collaborate with physicians, residents, nurse practitioners, and physician assistants in managing acute and chronic conditions, ensuring patients are connected with appropriate integrated services.
• Work closely with Community Health Workers to address non-medical determinants of health, connect patients to resources, and ensure continuity of care beyond the clinic.
• Facilitate interdisciplinary coordination with Behavioral Health, Nutrition, Pharmacy, Dental, and Vision teams to deliver comprehensive, whole-person care.
• Educate patients and families on treatment plans, preventive health practices, and chronic disease management, reinforcing the importance of integrated services.
• Proactively identify and close care gaps through patient outreach, follow-up, and accurate documentation to support HEDIS and UDS quality performance measures.
• Triage patient calls, walk-ins, and urgent concerns, directing patients to appropriate outpatient services in a timely manner.
• Support Internal Medicine residents by modeling integrated outpatient workflows and patient-centered practices.
• Coordinate referrals and follow-up visits exclusively within the outpatient clinic setting, ensuring patients experience smooth transitions across HHM Health service lines.
• Actively participate in outpatient team huddles, quality improvement initiatives, and integrated case reviews.
• Maintain compliance with HHM Health’s policies, infection control standards, and outpatient regulatory requirements.

• Diabetes Care:
  Coordinate care for a patient with diabetes by administering A1C tests, arranging a same-day consultation with the Nutritionist, ensuring medication adjustments through Pharmacy, and connecting with a CHW.
• Hypertension Management:
  Monitor blood pressure during visits, enroll the patient in remote BP monitoring if needed, collaborate with Behavioral Health for stress management, and ensure the patient follows up with Pharmacy for medication reconciliation.
• Preventive Care:
  Review preventive screening needs (mammogram, colonoscopy, eye exam), coordinate scheduling across service lines, and reinforce education with support from CHWs.
• Behavioral Health Integration:
  Identify patients with depression or anxiety during Internal Medicine visits, facilitate warm handoffs to Behavioral Health providers, and ensure follow-up is tracked and closed.

• Current unrestricted Registered Nurse (RN) license in the state of Texas (BSN preferred).
• Minimum of 2 years of nursing experience in an outpatient internal medicine, adult medicine, or integrated primary care setting preferred, but not required.
• Experience in a Federally Qualified Health Center (FQHC) or residency training clinic preferred but not required.
• Strong understanding of outpatient integrated care models, chronic disease management, and interdisciplinary collaboration.
• Familiarity with HEDIS/UDS quality measures and performance improvement strategies.
• Excellent communication,…