Registered Nurse - Home Health (Flexi)

Summary The Home & Supportive Care Registered Nurse (RN) provides excellent, clinically competent care and effectively interacts with patients/families and the healthcare team while maintaining professional nursing standards. The RN makes decisions and performs services in the best interest of the patient, positively contributing to the patient’s experience. The RN provides education, performs assessment, planning, implementation, monitoring, and evaluation of nursing care for acutely ill, chronically ill, terminally ill, and well patients with multiple managed conditions, ensuring cost‑effective and efficient utilization of health services. Essential Duties and Responsibilities Provide clinical care management services to identified eligible patients and coordinate care and transitions to achieve desired health outcomes. Foster collaboration, shared decision‑making, and partnership among clinical and non‑clinical team members. Perform patient/family/caregiver outreach per established protocols. Ensure patient eligibility for assigned Home & Supportive Care services and assist with discharge planning and coordination of admissions to home, facility, or other residence. Identify, enroll, and manage patients in Supportive Care Advanced Illness Management and Transitions of Care programs. Co‑manage a diverse population with one or multiple chronic conditions. Collaborate with patient, provider, and care team to develop and implement a plan of care that is medically appropriate and cost‑effective. Identify, execute, and track needed referrals to care and community resources. Provide resource management to improve care and patient experience, collaborating with Home & Supportive Care providers to implement a patient‑centered plan. Provide comprehensive care for patients with chronic conditions through Connected Care @ Home remote patient monitoring, making impactful judgment calls using clinical data tools. Provide ongoing remote clinical monitoring in partnership with providers, making informed escalation and triage decisions. Collaborate with the care team to monitor physiological data per outlined pathways and ensure seamless coordination according to each patient’s individual plan. Engage patients via text and voice/video calls, remotely reviewing patient data and health information. Showcase strong time‑management skills, enabling impactful judgment calls on patient care while balancing all other responsibilities. Act as a nursing member of the Home & Supportive Care team, performing patient‑care encounters as assigned. Supervisory Responsibilities Reports to: Nurse Manager and Clinical Coordinator. Supervises: Licensed Practical Nurses (LPN) and Unlicensed Assistive Personnel (UAP). Responsibilities: May delegate/assign duties to other members of the healthcare team. Education and Experience Minimum Required Education: Associate’s Degree in Nursing. Preferred Education: Bachelor of Science in Nursing. Experience: 1 year of inpatient, outpatient, or home‑based nursing experience is preferred. Certificates, Licenses, Registrations Applicants must have current licensure or be eligible for licensure as a Registered Nurse in the State of Virginia or a compact state. BLS certification required within 90 days. #J-18808-Ljbffr Chesapeake Regional Healthcare