Registered Nurse Home Health
Chesapeake, VA - USA
Job Summary
- Provide clinical care management services to identified eligible patients coordinating care and care transitions to obtain desired health outcomes.
- Foster collaboration shared decision-making and partnership among clinical and non-clinical care team members.
- Perform patient/family/caregiver outreach according to established protocols.
- Ensure patient eligibility for assigned Home & Supportive Care services and assist with discharge planning and coordination of admissions upon discharge to home facility or other residence.
- Identify enroll and manage patients in programs for Supportive Care Advanced Illness Management and Transitions of Care.
- Co-manage a diverse population living with one or multiple chronic conditions.
- Collaborate with patient provider and care team to develop and implement a plan of care to ensure medically appropriate cost-effective care.
- Identify execute and track needed referrals to care and community resources.
- Provide resource management to improve care patient experience and collaborate with Home & Supportive Care providers to effectively implement a patient-centered care plan.
- Provide comprehensive care for patients with chronic conditions through Connected Care @ Home remote patient monitoring and make impactful judgment calls using clinical data tools.
- Provide ongoing remote clinical monitoring to patients in partnership with their providers making informed escalation and triage decisions.
- Collaborate with care team to provide remote clinical monitoring of physiological data based on outlined pathways and ensure seamless care coordination according to each patients individual care plan.
- Engage with patients through text and voice/video calls remotely reviewing patient/client data and health information.
- Showcase strong time management skills enabling the ability to make impactful judgment calls on patient care while balancing all other responsibilities and time engagements.
- All Home & Supportive Care Registered Nurses may function as a nursing member of the Home & Supportive Care team performing patient care encounters as assigned.
- 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
- Minimum Required Education: Associate Degree in Nursing
- Preferred Education: Bachelor of Science in Nursing
- Experience: 1 year inpatient outpatient or home-based nursing experience is preferred
- Applicants must have current licensure or be eligible for licensure as a Registered Nurse in the State of Virginia.
- BLS within 90 days.
Required Experience:
IC
About Company
Chesapeake Regional Healthcare is a health system laser-focused on innovation, known for making medical history in the region and providing patients with truly personal care. Its hospital, Chesapeake Regional Medical Center, is the only independent, community-based acute care hospital ... View more