AERS and Nurse Monitoring (Full-time, Contractual)

The Community Health Nurse II performs assessments and nurse monitoring visits of elderly and/or disabled persons in their homes, hospitals, or institutions to determine community resources that are appropriate and available to meet the individual’s needs. This position also develops an individualized plan of care and serves as a health advocate and monitor for best living arrangement for the client.

POSITION DUTIES

Clinical (85%) Works with professionals from other disciplines to plan and implement healthcare services in the community; Collaborates on special projects in the community to promote wellness; Monitors the Long -Term Services Support (LTSS) tracking system for alerts related to referrals, updates client information (LOC, change in status, reportable events, etc.), and assures information is accurate; Tracks referrals assigned; Manages an individual Assessment and Nurse Monitoring caseload to provide nursing care to individuals, families and the community; Ensures confidentiality of written, electronic and verbal communication; Uses appropriate lines of communication within and outside the agency; Responds to requests for information in a timely manner; Provides interpretation and translation services according to agency policy; Provides education appropriate to meet the needs of those with functional needs; Documents work accurately and within agency guidelines; Communicates with other agencies and other members of the health team regarding clients’ needs and condition(s); Accesses community resources to benefit client; Maintains sensitivity to the multi-cultural needs of the Health Department clientele and staff; Participates in ongoing continuous quality improvement initiatives through interdisciplinary conferencing and self-monitoring of record standards; Participates in MDH audits/conferences or other management requested QA activities; Attends state-wide AERS meetings as required; Attends in-service training, community and general staff meetings to maintain professional competency and for the purpose of improving service to recipients; Meets with clients, families/representatives and other required professionals to perform a comprehensive assessment of individuals utilizing the STEPS assessment tool (for PASRR only) or interRAI assessment tool; Works with appropriate parties to develop an inclusive plan of care by coordinating services with clients, family, other disciplines, health service providers, and agencies; Completes nurse monitoring visits and follow-up as needed, and works with providers to ensure appropriate care; Serves as a community resource on long-term care issues; Promotes wellness and disease prevention; adapts teaching to the educational level of the client, family, caregiver; Provides educational content that may include, but is not limited to, guidance regarding personal safety issues, nutrition, medications, problem solving and access to resources and agencies; Provides follow-up to clients through face-to-face, telephone contact and written correspondence; Provides evaluation information to office clerk for billing purposes. Quality Assurance and Reporting (10%) Monitors Nurse Monitoring visit due report to gauge timeliness of delivery of service and makes recommendations for programmatic improvements; Participates in internal meetings, chart review process, audits and case study presentations to monitor services and ensure standards of best practice; Attends professional development related to assigned duties; Complies with standards for infection control and risk management; Maintains compliance with standards of care through training including, but not limited to: CPR certification, Local Health Department (LHD) Nurse Dispensing, Laboratory Operations, Personal Protective Equipment, FEMA trainings, and Data Security and Confidentiality compliance. Other (5%) Participates in local and regional committees, meetings and activities related to community health as appropriate; Participates in emergency preparedness drills, exercises and after-action hot washes; Accepts responsibilities for special projects as assigned; Participates in continuous nursing education and training that enables community health nurses to fully function under nursing COMAR regulations to promote public health through prevention education, chronic disease management or community outreach programs; Possesses a broad understanding of HCHD services and can refer to other programs. Participates in necessary drills and exercises, responds to emergencies as appropriate, keeps abreast of policies and procedures in the program, bureau and department. Completes all required trainings. Participates in quality improvement efforts within the program.

MINIMUM QUALIFICATIONS

Education: A Bachelor’s degree in nursing from an accredited college or university. Experience: None. Notes:

1. Candidates may substitute a Bachelor’s degree in a related field from an accredited college or university and one year of experience as a Registered Nurse for the required education.
2. Candidates may substitute two years of experience as a Registered Nurse for the required education.
3. Candidates may substitute U.S. Armed Forces military service experience as a commissioned officer in Nursing classification or Nursing or Health Care Specialist specialty codes in the Nursing field of work on a year-for-year basis for the required education.

DESIRED OR PREFERRED QUALIFICATIONS

The desired candidate should possess the following: Bilingual in Korean and/or Mandarin. Experience working with disabled and/or elderly populations. Experience with home visiting. Experience providing and managing consumer cases/services using an Electronic Health Records (EHR) and/or Electronic Medical Records (EMR).

LICENSES, REGISTRATIONS AND CERTIFICATIONS

1. Candidates for positions in this classification must possess a current license as a Registered Nurse from the Maryland State Board of Nursing, 4140 Patterson Avenue, Baltimore, Maryland 21215.
2. Employees in this classification may be assigned duties which require the operation of a motor vehicle. Employees assigned such duties will be required to possess a motor vehicle operator’s license valid in the State of Maryland.

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