Job Responsibility: Employment Type: Permanent FTE : 1.0 FTE (40 hours) Work Schedule : Monday - Friday

Summary of Position

Calgary Foothills Primary Care Network (PCN) is a group of family physicians and health care professionals in northwest Calgary and Cochrane collaborating with various external stakeholders to deliver the best possible primary care. Calgary Foothills PCN has established a team environment where individuals are encouraged to take initiative, be creative and contribute to ongoing decision-making

The PCN Health Team is comprised of health management nurses, clinical pharmacists, social workers, dietitians and behavioral health consultants. Team Members are co-located in member Patient Medical Home locations, centralized in clinic sites and deliver care in individual and group formats

Reporting to the Program Manager, Health Management Registered Nurses collaborate with family physicians, Calgary Foothills PCN multidisciplinary teams and community/external partners to provide patient-centered care for those with chronic disease and/or complex health conditions.

Key Responsibilities

Key aspects of the position may include, but are not limited to:

- Working with patients on self-management by providing coaching and education to help advance their skills, knowledge and self-efficacy in adopting healthy lifestyle behaviours that are meaningful to them
- Helping to build care plans with patients who have, or are at risk of, chronic health conditions through biopsychosocial health assessment, collaborative goal setting, applicable interventions based on patient readiness, regular follow-up and evaluation of progress
- Supporting the navigation of the health care system to connect patients and the medical home to applicable PCN,



community and health system resources as needed
- Promoting continuity of patient care through effective written and verbal communication with the Patient's Medical Home and those involved in the circle of care
- Building relationships and developing the Health Management Nurse role within and outside of the Calgary Foothills PCN team
- Identifying clinic/community needs and creating individual or group-based programs in collaboration with those partners
- Providing care through individual and facilitated group appointments
- Consulting with hospital, community and other Calgary Foothills PCN health care providers to ensure seamless care transitionsE
- Participating in development, delivery, evaluation and quality improvement of health programs and evidence-based practice
- Collecting and maintaining data for service indicators, progress reports and evaluations
- Adhering to and performing activities and care within the full scope of practice as defined under the Health Professions Act

Knowledge, Skills & Abilities

- Understanding of nursing scope of practice within a community setting
- Expertise in active listening and motivational interviewing
- Excellent written and verbal communication, organization and critical thinking skills
- Strong skills in collaborating with team members and physicians




- Maintains an individual's dignity and self-worth during all interactions
- Experience with trauma informed care an asset
- Excellent group facilitation skills
- Ability to provide evidence-based care
- Ability to work well in a team setting and independently
- Excellent computer skills are required
- Strong health assessment and documentation skills
- Ability to prioritize, manage time effectively, and be flexible in a very dynamic work environment
- Ability to work flexible schedule, including evenings/weekends, when required
- Accepts, implements and evaluates change with a positive attitude

Qualifications

- Graduate of an accredited degree program in nursing
- Licensed with the College of Registered Nurses of Alberta as a practicing member
- Montreal Cognitive Assessment (MoCA) certification required
- Experience or certification in Primary Care Behavioral Health considered an asset
- Must possess a valid driver's license and have access to a vehicle

Employment Requirements

- Completion of a satisfactory criminal record check and/or Vulnerable Sector Search

Diversity & Inclusion

- Our merit-based selection process during hiring ensures that all qualified candidates are considered. We invite people of all ethnic backgrounds, ancestry, religious beliefs, gender identities and expressions, sexual orientation, ages, family status and disabilities to apply for positions within Calgary Foothills PCN.

If your background matches the qualifications listed above and are looking for an opportunity with a dynamic organization that is making a difference in the community, please submit your resume and cover letter.

Please note that only candidates considered for an interview will be contacted.

📌 Health Management Nurse (Calgary)
🏢 Calgary Foothills Primary Care Network
📍 Calgary