Home Care Assessment RN

Home Care Assessment RN Complete Staffing Solutions, Inc - 3.7 Somerville, MA Job Details Full-time $55 - $60 an hour 18 hours ago Benefits Health insurance Qualifications Bilingual Microsoft Word Teamwork Microsoft Excel RN License Working with geriatric patients Case management SharePoint Translation Data collection Geriatrics Time management Full Job Description Home Care Assessment RN Notes from

Client:

No direct reports, this is a direct/individual contributor role Ideally looking for experience with older adults, conducting home visits, conducting

ADL/ IDL

assessments, comprehensive functional assessments, doing accurate and timely documentation, visiting nursing homes / facilities for fit with transition to community setting

Job Responsibilities and Performance Standards:

Respond to referrals from case managers, families, and community agencies in a timely manner and schedule a home visit as needed. Develop and complete an individualized, goal-directed client care plan, considering health status and social structure and reassess and/or revise care plan as appropriate. Provide in-service training and consultation regarding health issues to agency staff and community providers. Advocate, network, and educate families, clients, and community providers about SCES health service programs as needed. Collect data from skillful interview of consumer and/or family to determine physiological and psychological needs of client during scheduled home visit. Complete System for Award Management (SAMS) documentation including assessment data, progress note, and follow-up, for Medicaid and non-Medicaid programs in a timely, accurate, and confidential manner according to Division of Medical Assistance (DMA) regulations and Executive Office of Elder Affairs (EOEA) Standards. Update and maintain accurate and timely case records, including all forms and case documentation, according to agency, program and professional standards. Participate in Core Team Meetings with CSSM Program Manager and CSSM CM to identify and review nursing facility residents for participation in CSSM. Meet with discharge planner(s) (IDPT) at assigned nursing facility weekly to review MassHealth members/applicants' current stage of rehabilitation or recuperation. Identify Consumers who may require the most immediate need for CSSM services and those who wish to return to the community and communicate such with CSSM CM and Program Manage. Conduct in-person clinical eligibility screenings (CAE) based on a comprehensive health and functional and psychosocial assessment of MassHealth members/applicants seeking approval for MassHealth payment of nursing facility services. Participate in department quality improvement initiatives as needed. Participate in individual supervision, nursing and program team meetings and required agency meetings. Complete Clinical Decisions Support (CDS) and eligibility determination and follow-up within established timeframes and guidelines according to MassHealth regulations and EOEA requirements. Provide data for preparation of monthly statistical reports and maintain records. Participate in interdisciplinary case management model with direct service staff as scheduled following EOEA guidelines. Ensure HIPPA compliance. Perform other duties as assigned. If bilingual, provide interpretation and translation to Agency staff as needed.

Professional Standards and Conduct:

•

Leadership:

Ability to lead, inspire, and empower staff by demonstrating confidence and leadership presence. Passion and commitment to establishing and developing evidence-based programming for individuals to live in the setting of their choice with dignity and for as long as possible.

Collaborative and Responsive:

Regularly communicate, follow up, and use a team-driven approach. Respond thoughtfully and promptly to agency needs, requests, and inquiries; identify and build partnerships with key stakeholders. Demonstrates excellent organizational and time management skills to meet various deadlines, ensuring closed-loop communication. Ability to multi-task and maintain flexibility to adapt and adjust workload assignments based on various needs. •

Communication:

Skilled in verbal and written communication, demonstrating the ability to communicate information in various ways to meet diverse styles and cultural backgrounds.

Analytical:

Critical thinking skills, using logic and reasoning to identify the strengths and opportunities of alternative solutions, conclusions, or approaches to problems.

Attendance and Punctuality:

Dependable, punctual, showing flexibility when needed. Attends meetings as needed and is fully present and participates during those meetings.

Commitment:

Embodies SCES's core values and shows great integrity, accountability, and professionalism in all interactions. Aids in furthering SCES's mission and commitment to an inclusive environment.

Qualifications:

Graduation from a School of Nursing accredited by the National League for Nursing required, B.S.N. preferred. Valid license as a registered nurse in the Commonwealth of Massachusetts required. A minimum of one year of clinical experience required. One year of community health experience strongly preferred.\ Previous experience with elder population essential. Ability to work independently and collaboratively with health professionals, community agencies, service providers, and agency staff. Valid Massachusetts driver's license strongly preferred. Exceptional time management and organizational proficiency. Strong computer skills. Must be knowledgeable and comfortable using Adobe and MS Word, Excel, SharePoint, and other Microsoft 365 platforms. Experience with Wellsky a plus.

Pay:

$55.00 - $60.00 per hour

Benefits:

Health insurance

Work Location:

In person