Sanford Health, the largest rural health system in the United States, is dedicated to transforming the health care experience and providing access to world-class health care in America’s heartland. Work Shift: 8 Hours - Day Shifts (United States of America) Scheduled Weekly Hours: 40 Compensation: Salary Range: $32.00 - $48.00 . $10,000 Sign On Bonus available for Qualified Candidates! Union Position: No Department Details The Geriatric Care at Home Program currently supports 120 patients aged 65+ by providing clinic visits in the comfort of the patient's own home. The RNCM works closely with patients and their families, calls and questions, making home visits independently as well as with the clinician. Responsibilities include screening applicants to the program, managing schedules and orders, working closely with the providers and community resources. Ambulatory EPIC experience preferred. Hours are Monday through Friday 8am to 5pm with no weekends or holidays. Bachelor's degree in nursing required and RN experience preferred. Summary Responsible for utilizing the nursing process (assessment, diagnosis, outcomes/planning, implementation and evaluation) to provide individualized nursing care. Collects and relays information (assessment, screening, diagnostic testing results and risk stratification) to providers on both hospital and clinic patients enrolled in the approved programs. Job Description Develops and provides individualized patient education based on assessed needs. Develops and implements individualized care plan. Assists with the coordination of patient care across the continuum by collaborating with the inter-professional team and community partners. Works with the clinical team and may manage the disease registries by identifying and following up with patients not meeting clinical and evidenced-based goals as well as Sanford approved clinical guidelines. Provides services that focus on health and wellness. Provides healthcare leadership, coordination of services, and the implementation of evidence-based practice to support the overall goals of the designated setting and/or program. Applies population health care management strategies to panels of patients. Demonstrates competency and practices within the full scope of nursing expertise/knowledge and utilizes appropriate age and population specific standards as designated in their assigned clinical setting. Functions within the scopes and standards of nursing practice as outlined in the Nurse Practice Act and Administrative Rules in state of practice and licensure. The Sanford Professional Nursing Practice recognizes the Scope and Standards of Practice and the Code of Ethics for Nurses with Interpretive Statements as published by the American Nurses Association as the foundation of nursing care delivery and professional conduct. Qualifications Bachelor's degree in Nursing strongly preferred in Bemidji and Rapid City. Required in Fargo and Sioux Falls (Sanford USD Medical Center and Clinics). Required in Bismarck or enrolled and starting a Bachelor’s degree program within one year of hire with a completion date within three years upon date of hire into position. Required in Fargo Network and Sioux Falls Network, or employees hired after January, 2025, who do not possess a Bachelor’s degree in the required field, leadership may consider an educational plan with proven continuous action toward achieving a Bachelor’s degree in Nursing within five years of hire into position. Approval from the Nursing Executive for the market is required in order to waive the bachelor degree requirement (at time of hire). Additionally, for Rural Health Network facilities, for current employees, leadership may have considered acceptable qualifications and work experience equivalency based on facility size, rural market, and business need, prior to new Sanford education requirements. Graduate from an accredited nursing program, including, but not limited to, those accredited by the Commission on Collegiate Nursing Education (CCNE), Accreditation Commission for Education in Nursing (ACEN), or National League for Nursing Commission for Nursing Education Accreditation (NLN CNEA). Minimum of two years’ clinical experience preferred. Currently holds an unencumbered RN license with the State Board of Nursing where the practice of nursing is occurring and/or possess multistate licensure if in a Nurse Licensure Compact (NLC) state. Obtains and subsequently maintains required department specific competencies and certifications. Basic Life Support (BLS) is required and must be obtained within six months of employment. Must possess a valid driver’s license. Sanford is an EEO/AA Employer M/F/Disability/Vet.  If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-877-949-5678 or send an email to talent@sanfordhealth.org.