RN Case Manager - PACE Homecare - Per Diem

Job Description

The PACE RN provides home care services and case management to the participants of AtlantiCare LIFE Connection. The RN performs initial and annual assessments of participants in their home environment and implements plan of care with appropriate resources. The RN also is responsible for reviewing the plan of care and evaluates participant compliance. The RN provides skilled assessments, treatments and health education for participants in their homes, according to physician's order. The RN coordinates care with the Interdisciplinary team. The RN also maintains the participants' medical records with thorough documentation. This position may also support LIFE Connection clinic nursing operations as needed. The RN responds to and performs triage of acute participant issues.

The PACE Registered Nurse is a member of the multidisciplinary team working in collaboration with the physician. The RN utilizes the care process consistent with their license or certification including initiation of interventions within individual scope of practice. The RN is also responsible for overseeing any necessary coordination of the multidisciplinary plan of care and provides for its consistency with the medical treatment plan. The patient care process includes:

• Assessment - an orderly process consisting of the identification, gathering and organization of subjective and objective data pertaining to the patient/family/significant other.
• Planning - an organized step in the process that consists of the identification of the actual or potential problems and desired outcomes (goals) that result in a documented plan of care. The plan of care provides direction for the patient/family/significant other.
• Intervention - the specific interventions or orders that are implemented consistent with the plan of care and medical treatment plan.
• Evaluation - a step in the process that involves determining the effectiveness of the interventions in achieving the plan of care and determining the conclusions concerning the need for reassessment and revisions to the problems, goals, plan of care, and interventions. This step provides for documentation of required actions. Based upon findings identified during assessment and reassessment:
• Patients have problems identified and prioritized relative to biophysical, psychological, environmental, self-care, educational and social status.
• Goals are identified consistent with the problem to provide direction for patient care and health promotion.
• Education is consistent with the identified problem and associated goals and is seen as critical to creating an environment that promotes patient empowerment.

The Registered Nurse/Ambulatory assumes responsibility for continued professional and personal growth. This position supports organizational goals by providing quality customer service, participating in performance improvement efforts and demonstrating a commitment to teamwork and cooperation.

Qualifications:

EDUCATION: Graduate of an accredited school of Nursing required. Bachelor Degree in Nursing preferred.

LICENSE/CERTIFICATION: Current Licensure as a Registered Nurse in the State of New Jersey required. Valid NJ Driver's License required. Proof of registration and insurance required. American Heart Association BLS required upon hire or transfer. CPI required within 6 months of hire or transfer. Current incumbents must obtain CPI by 1/31/2027.

EXPERIENCE: Minimum 1 year with working with the frail or elderly required. Minimum 1 year experience as a Home Health or Long Term Care Nurse or equivalent experience required. Ability to perform diversified duties with time limitations with a high degree of accuracy required. Ability to use problem solving, critical thinking and priority setting skills required. Organizational skills required.

Performance Expectations:

Demonstrates the competencies as established on the Assessment and Evaluation Tool for this position.

WORK ENVIRONMENT

Potential for exposure to the hazards and risk of the hospital environment, blood borne pathogens, including exposure to infectious disease, hazardous substances, and potential injury. This position includes considerable reaching, stooping, kneeling, crouching, extensive standing, sitting and walking, the majority of the workday. This position also requires lifting approximately 25-50 pounds frequently and 50-100 pounds occasionally with assistance. Periodic traveling to company off site locations is expected. This position requires heavy mental stress demands and the ability to handle large numbers of interactions with multiple individuals compounded by constant interruptions.

The essential functions for this position are listed on the Assessment and Evaluation Tool.

REPORTING RELATIONSHIP

This position reports to department leadership and supervises incumbents as assigned.

The above statement reflect the general details considered necessary to describe the principle functions of the job as identified and shall not be considered as a detailed description of all work requirements that may be inherent in the position.