Job Title: Community Health Nurse
Location: Queens, NY - Ridgewood (PACE Center)
Schedule: 8:30 AM - 5:00 PM
Weekly Hours: 37.5
Under the direction of a Nurse Manager, the Community Health Nurse provides skilled care and routine clinical nursing assessment visits to PACE members and families utilizing all elements of the nursing process and in compliance with applicable laws, regulations, and agency policies. The Community Health Nurse primarily provides nursing visits in the member’s home but can also visit members in the PACE center, hospitals, nursing homes, and other settings as necessary for care coordination consistent with the PACE model of care. The Community Health Nurse is a core interdisciplinary team (IDT) member assigned to a PACE member in compliance with CMS PACE regulatory requirements.
Carry out the agency’s mission, philosophy, goals, and objectives within guidelines of agency policy and position function.
Interpret and implement the agency’s philosophy to staff and members of the community.
Assume responsibility for assignments given, seek supervision appropriately, and perform within the limits of their education and experience.
Know and conform to the law governing the practice of professional nursing and provide professional nursing care using all elements of the nursing process.
Assess and evaluate the health care needs of patients and families with consideration regarding physiological, psychological, social, and environmental factors.
Identify complete, accurate, and logical Uniform Assessment System (UAS) for NY and appropriate sequencing of diagnoses in collaboration with the PCP to maintain compliance with state and federal regulations.
Participate in mandatory PACE comprehensive care planning meetings routinely as required by PACE regulations. Collaborate with all members of the IDT in developing a comprehensive care plan based on member-specific needs, physician orders, UAS-NY CAPS, other IDT assessments, members’ specific parameters, and identified goals that are respectful of member, family, community, and agency resources.
Implement the nursing care plan and revise it whenever necessary by regularly assessing, observing, and evaluating the patient’s condition, needs, and response to care and make appropriate nursing judgments and decisions for care plan revision.
Initiate and apply appropriate preventative, therapeutic, and rehabilitative nursing procedures and techniques.
Administer medications and treatments as prescribed by the PCP. Ability to independently perform skilled nursing procedures and techniques based on the changing nursing needs that the member requires.
Teach the patient and family/caregivers self-techniques whenever appropriate and provide instruction regarding medication, diet, safety, and treatment modalities in accordance with the plan of care.
Recognize and utilize additional opportunities for health counseling/education with patients, families, and other caregivers and provide them with information that will facilitate decisions regarding the promotion, maintenance, and restoration of health.
Delegate responsibility appropriately and supervise ancillary personnel in a manner that will assure quality care and compliance with the care plan.
Evaluate for and promote a safe environment for the patient and comply with National Patient Safety Goals.
Complete, maintain, and submit all required documentation that is timely (in compliance with agency policy), accurate, and relevant.
Meet all requirements for UAS-NY assessor function: timely completion within regulatory standards, follow-up assessments, and significant change assessments as needed.
<
Experience & Skills Required
Minimum of one (1) year general clinical nursing experience in a certified home health agency (CHHA), acute care, medical-surgical, and/or critical care experience required. Clinical nursing experience must be within one (1) year from date of hire or transfer.
Minimum of one (1) year of experience working with a frail or elderly population or, if the individual has less than one (1) year of experience but meets all other requirements, must receive appropriate training from the PACE organization on working with a frail or elderly population upon hiring.
Possess and maintain good physical stamina and mental health, including satisfactory health clearance as required by NYS regulations and agency policy.
Current Driver’s License, required insurance, and car available for work as required.
Current New York State license to practice as a Registered Nurse.