PACE KC RN Care Manager

This Registered Nurse position has the primary responsibility to participate as a member of the interdisciplinary team to assess, plan, implement and evaluate care provided in the patient/participants place of residence. This nurse will actively participate in coordination of all aspects of patient’s care, in accordance with current professional standards and practice of . PACE KC/Swope Health 24/7 nursing coverage rotation. This position is supervised as designated on the agency organizational chart.

Duties & Responsibilities
People
• Maintains clinical competencies.
• Provides patient/caregiver education and training specific to identified needs.
• Collaborates in the provision of care, treatment and services with the interdisciplinary team to meet patients’ needs and maintain continuity of care between disciplines, programs, services and with other organizations as needed.
• Participates in agency activities to include interdisciplinary team meetings, staff meetings, and other committee meetings as assigned and educational opportunities.

Service
Provision of skilled nursing care which includes:
• Collaborates with the physician(s) and acts as liaison for the care coordination of the designated case load.
• Assesses patient needs and provides services within scope of practice and based on individualized plan of care appropriate to the patient’s needs, strengths, limitations and goals.
• Communicates/collaborates with contracting providers regarding services provided.
• Evaluates care, treatment and services to include active participation in interdisciplinary team meetings.
• Assesses for discharge and/or transfer needs and facilitate the process to ensure that continuity of care, treatment and service is maintained.

Quality
• Follows policies and procedures in the assessment, planning, intervention, evaluation and documentation of patient and family care.
• Performs clinical duties within the nursing scope of practice.
• Documents in electronic records within stated standards provide complete and accurate supporting documentation.
• Participates in the agency performance improvement program.
• Participates in surveillance, prevention and control of infection.
• Participates in environmental safety and equipment management procedures.
• Utilizes information management to support decision making to improve patient outcomes, improve health care documentation, assure patient safety and improve performance in patient care, treatment and services.

Growth
• Completes annual mandatory education requirements.
• Develops partnerships within the community and educates community members and healthcare providers about Midland Care services. Provides education related to hospice to staff in alternate care settings (nursing homes, hospitals, assisted-living facilities, etc.)

Finance
1. Utilizes company resources in a prudent and appropriate manner. It is a good steward of company resources.
2. Manages patient care within accepted standards for utilization of DME, medications and supplies.
3. Follows agency procedures/standards for productivity, attendance, use of PTO and approval of overtime.
4. Reviews and evaluates requests for approval from accounts payable for patient specific requests.

Other Essential Duties & Responsibilities:

• Upholds PACE KC/Swope Health mission and values; communicates philosophy; supports patient and family care when needed; maintains confidentiality and respects autonomy.
• Provides good customer service, participates in performance improvement, and collaborates with staff.
• Maintains a professional appearance and is reliable and punctual.
• Understands relevant computer systems and software.
• Accepts duties cooperatively and performs all assignments effectively while following organizational policies and procedures.

Qualifications
Required:

• Current unrestricted State of Missouri License to practice as a Registered Nurse.
• One-year professional medical-surgical experience.
• Availability of reliable transportation is required.
• Knowledge of professional nursing theory, standards of nursing practice, scope of practice and relevant statutes and regulations.
• Ability to prioritize work, meet deadlines, handle multiple projects, pay strong diligence and accuracy and work under pressure in a cooperative work environment.
• Must be self-directed, motivated and flexible.
• Must possess a valid Driver’s License, automobile liability insurance and maintain a Motor Vehicle Record (MVR) that meets organization’s insurability standard.
• Availability of reliable transportation is required for this position. Have a minimum of one year of experience working with the frail or elderly population.

Preferred: Home Health or Hospice experience preferred.

Physical Demands

• Must be able to continuously stand and walk frequently squat, climb stairs, bend to the floor, reach over the shoulder, kneel, twist, sit, lift patients, and remain in uncomfortable positions for prolonged periods of time.
• Must have sufficient visual acuity to continuously note changes in patient condition (breathing, color, skin integrity) and to read a thermometer, sphygmomanometer dial, and other instruments.
• Must have sufficient hearing acuity to auscultate BP, hear verbal instructions and communication from clients, respond to emergency alarms, and answer the telephone.
• Must be able to concentrate on moderate details with frequent interruptions, attend to specific functions for 10-25 minutes, remember multiple tasks and assignments over an 8–12-hour period, and understand and relate specific ideas and concepts.
• Must be able to deal effectively with stress, patients and their families, multiple tasks, noise, interruptions, and emotional loss, and work cooperatively with other members of the interdisciplinary team while maintaining a pleasant and professional demeanor.
• Must be able to travel to and access patient homes where conditions may be adverse due to weather, environment, or patients’ lifestyles.

HIPAA Security Class
Check one:
General: Access to basic demographics. No access to “medical records” forms.
x Clerical/Clinical: Access to medical records to modify or create. No access to billing or software maintenance.
Billing: Access to billing screens for reimbursement issues.
Admin: Total access to everything including system maintenance.
Exec: Total access to view everything, can run reports, input time sheet information, etc.

Exposure Control Category
Category I: This position has the inherent potential for mucous membrane or skin contact with body substance, or a potential for spills or splashes of them. Employees in these positions must follow the Preventative Measures as established by the Midland Care Exposure Control Plan.

Equipment Used
Telephone, laptop computer, FAX machine, motor vehicle, medical equipment as identified for assessments and interventions, and other equipment as needed.

Work Environment
Individual must wear appropriate business attire and spend virtually all of the time inside.