Role Description
The RN reports to the Clinical Manager or designee, with accountability for providing strategy, judgment, organization, and evidenced-based analysis to influence decisions, and directly to meet Grace at Home’s requirements. They should embody Grace at Home’s core values, including:
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Trusted
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Empathetic
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Committed
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Humble
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Creative
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Community-Minded
At Grace at Home, we don’t have patients or customers – we have Family Members.
The individual in this position works as part of an interdisciplinary team to ensure high quality outcomes for patients/families struggling with chronic disease management.
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Works with member and care team to conduct appropriate assessments that result in a nursing care plan prioritized by the patient and caregivers.
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Conducts in-home or tele-health assessments, as directed by the model and leadership.
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Tracks nursing care plan outcomes, interventions, and continues to reassess the patient's needs as appropriate.
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Utilizes care pathway templates by condition with risk levels and member actions by event type.
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Deploys Remote Patient Monitoring and Patient Self Reporting for High-Risk Chronic Conditions.
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Conducts transition of care visits both virtually and in-home to ensure smooth transition from an acute care setting to home.
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Provides care coordination for Grace at Home’s Family Members including patient navigation, chronic disease management/education and interdisciplinary collaboration.
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Engages members in taking a proactive role for managing their health, medications, treatment and mental health needs.
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Follows evidence-based guidelines to facilitate closure of gaps in care.
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Uses the electronic medical record or clinical management platform to conduct care coordination activities.
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Participates in team-based rounds to support and contribute to ongoing program design and development.
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Demonstrates an ability to identify and shift priorities within work assignment to effectively manage patient care load.
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Performs other job-related duties as assigned.
Qualifications
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BSN Required. MSN or other healthcare related graduate level degree, a plus.
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At least 3 to 5 years of relevant clinical experience.
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Unrestricted RN licensure in the state of the hiring Grace at Home location; preferably an enhanced-compact-multi-state license (eNLC).
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Knowledge and prior use of Microsoft Office products or other similar office software.
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Unrestricted driver’s license in the state of hire.
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Experience with EMRs.
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BLS certification.
Requirements
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Ability to examine/analyze and evaluate information to form a reasoned judgement.
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Utilize the nursing process to evaluate a member’s bio-psychosocial conditions.
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Ability to identify a problem, consider options and implement a solution.
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Excellent verbal, written communication, and presentation skills.
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Ability to build and effectively manage relationships with patients and community business leaders.
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Good judgement, impeccable ethics, and a strong team player.
Benefits
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Competitive Compensation: We offer competitive salaries to attract and retain the best talent.
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401(k) with Employer Match: Plan for your future with our 401(k) plan and a generous 4% employer match.
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Comprehensive Medical Plan: We proudly offer a comprehensive medical option with an employer contribution.
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Dental & Vision Coverage: Maintain your oral and eye health with our employer-paid dental and vision plans via MetLife.
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Employer-Paid Insurance: Life, Short-Term Disability (STD), and Long-Term Disability (LTD) insurance are provided at no cost to you.
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Generous Paid Time Off: Enjoy ample time off for rest and rejuvenation with generous PTO, holidays, and wellness time.
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Continuing Medical Education (CME) Allowance for APPs: Stay at the forefront of your field with our CME allowance.
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Commuter Benefits: Save on your commute with our commuter benefits program.
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Mileage Reimbursement: Get reimbursed for work-related travel expenses.