Job Title: Registered Nurse
Profession: RN
Specialty: Home Health
Duration: 260 days
Shift: 5x3 days
Hours per Shift: Not specified
Experience: Two years in a home setting within the last fifteen years
License: Current RN Licensure in Client
Certifications: BLS required before the start date
Must-Have:
Bilingual Spanish-English proficiency strongly preferred.
Experience conducting comprehensive assessments of patients.
Description:
Required Licensure: Current RN Licensure in Client.
Bilingual Spanish-English proficiency strongly preferred.
Two years of experience in a home setting within the last fifteen years is required.
This may include working in the field for a Certified Home Health Agency, Licensed Home Care Service Agency, or Managed Long-Term Care.
Conducting assessments similar to UAS such as OASIS is required.
Providing primary care to homebound individuals is necessary.
Experience in care management for individuals receiving home and community-based services, including hospice and assisted living, is essential.
Home care experience as a paraprofessional or Licensed Practical Nurse caring for a minimum of two patients per week is required.
Preferred Qualifications:
Experience conducting assessments in UAS-NY, especially in the last 365 days.
Experience caring for a geriatric population and managing chronic diseases, especially in a home setting.
A combination of home care experience as a paraprofessional or LPN alongside RN experience is preferred.
Responsibilities:
Perform initial in-home pre-evaluation of patients, evaluating health status, strengths, care needs, and preferences.
Guide the development of individualized long-term care service plans.
Review consumer medical documentation and relevant health referral forms.
Enter evaluation data into the electronic evaluation form and transmit as required.
Document any concerns, conflicting information, and other issues that arise during the evaluation process.
Emphasize continuity of care, reducing or eliminating fragmentation, duplication, and gaps in the treatment plan.
Discuss healthcare options, necessary supports, service vendor options, and waiver options with consumers.
Initiate communication between the Call Center and eligible consumers for enrollment into a managed care health plan.
Enhance communication and collaborative relationships with interdisciplinary team members to improve care coordination and facilitate service delivery.
Collect quality review data and any necessary documentation to support outcome measurements and record case notes.
Identify opportunities for health promotion and illness prevention.
Maintain a comprehensive understanding of community resources and payer requirements for the target population.
Meet all standards established for this position as outlined in corresponding annual performance criteria and bonus template.
Perform other duties as assigned by the Regional Nurse Manager or other project management.
All candidates must be aware of their responsibilities in conducting in-field assessments.
Candidates must provide all required information such as aliases used, current and previous addresses, and current phone numbers and emails.