Community Health Registered Nurse

Position Summary

The Community Health Registered Nurse (RN) provides comprehensive nursing services that bridge clinical care and community-based healthcare delivery through a collaborative partnership between Novus Health and Peter & Paul Community Services (PPCS). This position delivers patient-centered nursing services across outpatient clinics, supportive housing programs, shelters, and community settings to improve health outcomes for vulnerable populations.

The Community Health RN performs health assessments, medication management, care coordination, referrals, patient education, prior authorizations, and clinical documentation while working collaboratively with physicians, behavioral health providers, case managers, and community partners. The role promotes whole‑person, trauma‑informed care that addresses both medical and social determinants of health.

• Perform comprehensive nursing assessments in clinic and community settings.
• Conduct wellness visits, health screenings, and ongoing health monitoring.
• Assess physical and behavioral health needs and develop appropriate nursing interventions.
• Monitor chronic medical conditions and communicate changes to providers.
• Obtain and document vital signs and health histories.
• Administer medications by approved routes in accordance with provider orders and nursing standards.
• Monitor medication adherence, effectiveness, and potential side effects.
• Provide medication education and self‑management coaching.
• Ensure accurate medication documentation.

• Coordinate care between Novus Health providers, specialists, hospitals, pharmacies, behavioral health providers, and community agencies.
• Assist patients with referrals and specialty appointments.
• Manage medical referrals and obtain required documentation.
• Complete insurance prior authorizations for medications, imaging, and specialty services.
• Follow referrals through completion to ensure continuity of care.
• Collaborate with interdisciplinary teams regarding patient treatment plans.

Provide nursing services across multiple community programs, including:

• Supportive housing programs
• Homeless outreach programs
• Subtsance use treatment
• Behavioral health programs
• Shelter‑based healthcare services
• Community wellness initiatives

• Medication management and monitoring
• Health assessments
• Wellness checks
• Care coordination
• Behavioral health support
• Health education
• Provider communication
• Documentation review
• Regulatory compliance
• Staff consultation
• Resource navigation
• Clinic coordination
• Follow‑up after hospitalizations or emergency visits
• Vacation and emergency nursing coverage across programs

• Educate patients regarding medications, chronic disease management, preventive care, nutrition, and healthy lifestyles.
• Reinforce provider treatment plans.
• Promote health literacy using trauma‑informed communication techniques.
• Encourage patient engagement in preventive healthcare services.

• Maintain timely, accurate documentation in the electronic medical record and/or paper record
• Complete nursing documentation within established organizational time frames.
• Maintain confidentiality in accordance with HIPAA requirements.
• Participate in quality improvement initiatives and documentation audits.

• Participate in interdisciplinary care team meetings.
• Collaborate with physicians, nurse practitioners, behavioral health clinicians, case managers, pharmacists, and community partners.
• Provide clinical consultation to staff when appropriate.
• Support organizational initiatives that improve patient outcomes.

• Travel between Novus Health clinics and PPCS community locations.
• Participate in emergency response and crisis interventions as appropriate.
• Maintain clinical supplies and equipment.
• Occasional on‑call duties
• Perform other duties as assigned.

• Active Registered Nurse (RN) license in Missouri.
• Graduate of an accredited nursing program.
• Minimum of two (2) years of nursing experience in community health, public health, primary care, behavioral health, infectious…