Registered Nurse

Description Facilitate receiving all medical records from the patient’s primary provider and specialists. Review medical records. Complete consents with patients. Enroll patients in Care Management, if they meet eligibility criteria. Initiate a Care Management Plan of Care, if the patient is eligible. Capture all diagnoses at the highest specificity by creating gaps and ensure they are accepted. Complete AWV’s to be reviewed by the provider. Complete cognitive impairment screenings. Complete Social Determinants of Health (SDoH) assessments and/or screenings. Complete ACP’s to be reviewed with the patient by the provider. Evaluate for home health, hospice, palliative, or consults with Your Health Specialty Division, etc. Evaluate for RPM devices, resources, or tools that may improve the patient’s quality of life. Communicate and coordinate care. Reconcile prescribed and OTC medications, vitamins, supplements, herbal remedies, and other treatments. Provide post-discharge education. Evaluate for adaptive equipment and DME. Evaluate for safe environment. Evaluation of acute condition(s) or follow-up from previous visit. Appropriately and accurately document and log Care Management activities. Work in conjunction with care team to keep the patients Care Management care plans up to date. Qualifications RN License Looking for home nurses for Waynesboro, Hephzibah, Wrens, Central Augusta. #J-18808-Ljbffr