Lead Registered Nurse, Advanced Illness
Company: Senior Care Action Network Foundation
Location: Long Beach
Posted on: February 23, 2021
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Job Description:
We are currently seeking a Lead Registered Nurse, Advanced
Illness to provide geriatric evaluations to SCAN members at the
HealthCHEC program. The program has been in operation since 2013
directed by a Geriatrician. This opportunity will allow you to work
and collaborate with a Geriatric trained physician and Medical
Director, Dr. Dan Osterweil. Dr. Osterweil, MD, FACP, leads the
senior-focused HealthCHEC Comprehensive Health Evaluation
operations. He completed his geriatrics fellowship at UCLA. His
areas of expertise include cognitive and functional assessment,
management of dementia and continuous quality improvement.
HealthCHEC- Comprehensive Health Evaluation Center is an innovative
member centered--program were members of SCAN are invited to
complete their Personal Health Assessments.--The Personal Health
Assessment includes reviewing and completing a detailed medical
history, complete review of tests, screenings and preventative care
the member has received, review of current medications and a
complete physical exam. Upon completion of the Personal Health
Assessment, our--program develops a recommended care plan,
discusses it with the member and sends a report to the member's
Primary Care Physician.-- Job Summary --Lead the delivery of
patient services through HealthCHEC's Advanced Illness Program to
provide clinical care and coordination of care to culturally
diverse older adults with advanced illness and to support their
goals in improving/maximizing quality of life and other care plan
goals/needs. Your Key Duties and Responsibilities: Oversee the
deployment of clinical services to older adults and provide
direction to other staff providing patient support through
HealthCHEC's Advanced Illness Program. Deliver clinical care
services to patients with particular attention to their medical,
physical and psychological needs. Complete relevant assessments and
procedures as appropriate (e.g., comprehensive assessment (physical
and psychosocial); functional assessment; wound assessment and
care; pain assessment). Ensure adherence to and that patient's
needs are met through written care plan approved by HealthCHEC
clinical leadership and discussed verbally with the patient and/or
his/her representative. Demonstrate focus on improving/maximizing
quality of life goals and needs. Drive and/or support care
coordination as appropriate, including identify/utilize resources,
referrals such as Home Health PT/OT, Hospice, Pharmacy, Dietary,
DME, and other consults. Serve as liaison between the
patient/family and broader HealthCHEC team. Provide care management
services to patients and their families, as appropriate. Exhibit
empathy and understanding of patients' case, serving as resource to
patients, families/caregivers. Demonstrate awareness of varying
approaches, beliefs and views based on patients' cultural and/or
religious beliefs. Convene weekly/bi-weekly huddles to review
cases. Present cases at and participate in weekly team case
conference per guidelines. Discuss during case conference complex
health care issues for both discharge decision-making and teaching
purposes. Contact patient's physician as needed to discuss health
problems identified during assessments, initial and follow-up
visits. Provide education to the patient or family member regarding
self-care, hygiene, nutrition and other related topics (e.g.,
non-pharmacologic management of dementia related behaviors).
Provide ongoing health education to non-clinical staff members.
Lead and train other HealthCHEC staff (Patient Care Technicians,
Schedulers) in providing services through the Advanced Illness
Program. Oversee staff in day to day operations to ensure quality
service for patients. Communicate expectations, monitor
performance, and provide feedback. Esure staff adherence to
systems, policies, and procedures to provide an efficient,
effective and safe work environment. Collaborate with HealthCHEC
staff, patients, patients' family members, medical group PCP and
clinical team, health plan patient-facing teams (Complex Care
Management) and other professionals involved in the care of the
patient to assure appropriate services. Maintain monthly
documentation of patients seen along with other documentation of
relevant contacts with patients, partnering providers, and health
professionals. Other duties as assigned. Your Qualifications:
Keywords: Senior Care Action Network Foundation, Long Beach , Lead Registered Nurse, Advanced Illness, Healthcare , Long Beach, California
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