Job description

** This position covers Acushnet, Assonet, Attleboro, Berkley, Dartmouth, Dighton, Easton, Fairhaven, Fall River, East Freetown, Mansfield, Mattapoisett, New Bedford, North Attleboro, North Dighton, North Easton, Norton, Raynham, Rehoboth, Seekonk, Somerset, Swansea, Taunton, Westport**

• Performs episodic urgent medicalvisits to ensure that members are given timely and appropriate medical care in order to avoid emergency room or hospitalization.
• Conducts a variety of assessments within their scope of practice; including but not limited to MDS ( in Massachusetts), and LTSS assessments.
• Facilitates and/or delivers preventative care to members according to the guidelines deemed appropriate by CCA.
• Collaborates with CCA Care Partner and community based PCPs/ Specialists, as needed.
• Collaborates with CCA interdisciplinary site team to ensure comprehensive member needs are consistently met
• With a signed Provider's order, performs Intermittent Skilled Care as necessary (e.g., wound care, medication management, routine and chronic disease assessment and other skilled needs).
• Provides education to member and family, as appropriate
• Assesses quality gap reports at each face to face visit; collaborate with care team and PCP to close these gaps
• Performs joint visits with other care team members as appropriate to address complex care needs
• Attends Interprofessional Team Meetings
• Participates in RCA as appropriate
• Documents using an Electronic Medical Record, in an effective manner while strictly adhering to CCA policies and procedures.
• Utilizing and depending on CCA internal resources, ensures that the plan of care is implemented in a timely manner.
• Participates in weekend and holiday rotation which may include working Saturday, Sunday or a weekday holiday up to two times a year.
• Provide clinical care to members via telehealth technologies (video, chat, etc.) for a clinically appropriate clinical care and care management services.

Qualifications:

• Associate's Degree or Diploma in nursing required, Bachelor's Degree in nursing preferred.
• Meaningful clinical experience in primary care or care management, including:
• 5+ years' experience as Registered Nurse in a high touch clinical environment or home care; OR 2+ years caring for patients/members with complex medical, behavioral health, and social needs
• Registered Nurse with licensure in good standing in the state assigned to work
• Certified in Basic Life Support for Healthcare Providers.
• Current CPR or Basic Life Support (BLS)
• Demonstrate an understanding of the benefits of CCA's product lines
• Is able to conduct and document a Pain Assessment
• Is able to use SBAR Communication
• Is able to conduct and document Home Safety Evaluation
• Is able to provide Wound Care (simple & complex)
• Is able to utilize an Electronic Medical Record
• Is able to use on-line training platforms
• Demonstrates an understanding of the Model of Care
• Demonstrates an understanding of the benefits of each program
• Is able to review welcome packets and obtain consent forms and attach them to EMR
• Demonstrates an understanding of when an updated assessment is needed
• Is able to complete a comprehensive Assessment
• Is able to complete and update a Care Plan that meets CCA requirements
• Demonstrates an understanding of LTSS
• Demonstrates an understanding of how to use CDSTs when ordering services
• Is able to complete and lock all required notes and telephone encounters within 48 hours
• Participates in case discussions
• Ability to conduct Crisis assessments over the phone and deploy assistance as needed
• Able to lead a family/team meeting for the purposes of discharge planning
• Obtains/documents a comprehensive history
• Demonstrates knowledge and ability to use screening/ assessment tools to Fall risk assessment
• Assist with Advanced Care Planning, including establishing goals of care with members
• Willing to learn and utilize telehealth technologies (video, chat, etc.), when appropriate, for a variety of clinical care and care management services.
• English required, Bilingual preferred

Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled

laviolettawines.com.au is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, laviolettawines.com.au provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, laviolettawines.com.au is the ideal place to find your next job.