Participates as a member of the PACE Interdisciplinary Team in the planning, implementation and evaluation of care plans that meet the objectives, standards and policies of the PACE model of care. Assesses the participants' needs for home care services and schedules, monitors and evaluates home care services. This position is full time M-F 8am to 4pm with great work life balance and benefits.

Essential Responsibilities:

Reviews the OT homecare assessment and determine if need for home visit. Conducts and schedules monthly Homecare rounds to review homecare services and participates in meeting with contracted vendors as indicated. Meets weekly with the OT to review need for homecare services and assists the primary nursing team with authorization of services. Provides home visits on an as needed basis to triage changes in medical, cognitive or functional status and updates the teams on an as needed basis. Offers solutions to revise or modify care plans to better meet the needs of the participants and participates in the care planning process. Completes appropriate authorization forms for home care services on a 6 month schedule. Effectively communicates with participants and families regarding home care services and addresses any and all issues/concerns within 3 working days, or immediately if necessary. Keeps the IDT informed of any and all issues/concerns. Participates in family meetings or case conferences, as necessary. Records and maintains accurate and timely documentation in the participants' charts. Follows all LTC participants by performing annual/semi- annual nursing assessments. Provides rotating coverage for after hours on-call system and supports site coverage as needed. Ensures that all interactions with participants, families and vendors are conducted in a manner that adheres to the highest standards of care and the highest degree of professionalism. Ability to pass a fit test. Position requires mask where seal is critical. Incumbent is required to not have facial hair that interferes with a tight seal of the respirator. Frequent local travel. Performs other duties as assigned.

Job Specification:

Successful Completion of an Accredited R. N. Program. Bachelor of Science Degree in Nursing, preferred. Current Licensure as a Registered Nurse in the Commonwealth of Massachusetts. Current CPR certification. A minimum of 2 years of experience working with a geriatric population. A minimum of 2 years of working in a community health setting. COVID vaccinated preferred.

Salary range:

RN salary range:80k to $104k LPN salary range: 74k to 88k EEO Statement Element Care is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, sex, color, religion, national origin, sexual orientation, protected veteran status, or on the basis of disability. Element Care is committed to valuing diversity and contributing to an inclusive working environment.

Compensation details:

80000-104000 Yearly Salary