Mobile Health Unit Support
Conduct health screenings (e.g., blood pressure, A1c and other appropriate Point of Care testing) and provide preventive health education
Collaborate with Program Coordinator and Community Health Worker to ensure efficient client flow and follow-up
Identify patients in need of further care and facilitate warm handoffs to appropriate Care Ring programs and other community referral partners
Nurse Case Management
Serve as Nurse Case Manager for patients enrolled in Physicians Reach Out and Care Ring Clinic
Conduct comprehensive assessments and develop person-centered care plans addressing clinical, social, and environmental needs
Coordinate referrals to specialty care, home health, therapy, long-term care, and community resources
Liaise between patients, providers, and insurers to ensure continuity and access to care
Advocate for patient needs and support navigation of healthcare systems and insurance coverage
Patient Education & Advocacy
Educate patients and families on chronic disease management, medication adherence, and health literacy
Promote self-management and independence through coaching and resource sharing
Provide culturally sensitive education and materials tailored to diverse populations
Documentation & Communication
Maintain accurate and timely documentation in electronic health records and care management systems
Participate in case conferencing, staff meetings, and interdisciplinary planning sessions
Communicate effectively with clinic staff, CHWs, and administrative teams to ensure coordinated care
Ensure confidentiality and compliance with HIPAA and organizational policies
Qualifications and Education Requirements
BSN preferred (RN with an Associate degree considered with relevant experience)
Current RN license in good standing in North Carolina
Minimum 2-year clinical nursing experience, preferably in community health, primary care, or FQHC settings
Experience in case management or care coordination preferred
Experience working with underserved populations and maternal/child health preferred
Current CPR/BLS certification
Covid 19 vaccination and proof is required
Valid driver’s license and insured automobile
Proficiency in Microsoft Office Suite and electronic health record systems
Strong organizational and time management skills with the ability to work independently and collaboratively
Cultural competency and sensitivity to diverse patient populations
Must be able to work a flexible schedule, including some evenings and weekends
Ability to lift up to 25 pounds and perform physical tasks associated with mobile unit operations
Preferred Skills
Bilingual (Spanish/English)
Knowledge of services available in the Charlotte-area community
Experience in mobile health or outreach settings
Familiarity with trauma-informed care and motivational interviewing
Strong clinical judgement, problem-solving, and crisis intervention skills
Commitment to serving uninsured and Medicaid patients and addressing social determinants of health
Experience using Epic for clinical documentation
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