RN-Pace Home Care Coordinator

Schedule: Day Shift. Monday-Friday 8-430p, on-call rotation.

About the Position:

Under the direction and supervision of the Home Care Coordinator and Clinical Manager, assists with participant medication management and implementation of nursing services in the home setting as needed for the Reid Health PACE program. Works closely with PACE care providers to achieve quality outcomes for the participant. Communicates participant condition to primary caregivers, providers, and the interdisciplinary team. Accepts other duties as assigned by the Clinical Manager and within the scope of practice.

Overview of Responsibilities

• Provide skilled nursing care in the home environment under the direction of a Provider.

• Participate in the development and revision of the participant's plan of care as a member of the IDT.

• Coordinate and supervise all nursing care for Reid Health PACE participants in the nursing home/boarding home according to program standards, including interaction with facility staff and participation in the Home Safety Assessment.

• Provide basic medical care, including wound care, medication management, and collecting specimens as directed by the Provider.

• Access home care services system, make recommendations, and offer solutions to revise or modify systems to better meet participant needs.

• Actively participate in Interdisciplinary Team Meetings.

• Assist with pre-enrollment in-home assessments.

• Instruct and educate participants and families on medication and treatment instructions.

• Monitor and report changes in participant condition to the Provider.

• Ensure chart documentation is completed in a timely manner and in accordance with practice policy and procedure.

• Perform lab tests as needed and as directed by the Provider; prepare specimens for in-house and reference labs.

• Observe, record, and report participant's condition and reactions to drugs and treatments to Providers.

• Maintain commitment to Participant Satisfaction and Participant Safety.

• Maintain participants' medical records and fulfill Reid Health PACE charting and reporting requirements.

• Respond to and perform triage of incoming telephone calls; may be assigned to Center's Triage. Provide emergency care as needed.

• Participate in administering participant vaccinations and document appropriately.

• Prepare equipment and assist providers during treatment, examination, and testing of participants.

• Assist other staff in the home setting or clinic during appointments and emergencies.

• Maintain supply inventory for clinic medication room.

• Effectively communicate in clinical meetings or any other meetings as assigned.

• Provide support to participants across all care settings.

• Monitor operational compliance with OSHA regulations, Infection Control protocol, and agency policies and procedures.

• Participate in and support Quality Improvement initiatives.

• Participate in continuing education classes, staff meetings, and required trainings; maintain professional affiliations and any required certifications.

• Comply with CMS PACE regulations as they pertain to this role.

• Participate in family meetings, staff meetings, in-service and training programs, staff orientation and education activities, rehab services meetings, and Quality Improvement activities.

• Provide on-call coverage on a rotating basis with other nursing staff to triage, advise, and coordinate participant care within scope of practice.

• Perform other duties as required or requested.

This list of duties and responsibilities is not intended to be all-inclusive and can be expanded to include other duties or responsibilities that management deems necessary.

Education & Experience

• Education Required: ASN

• Education Preferred: BSN

• Experience Required: A minimum of one year experience working with the frail or elderly population

• Experience Preferred: 3+ years of experience working in a health care facility or practice

Licensure and Certification

• Licensure: License and current registration to practice as a registered nurse in Indiana

• Certifications: BLS