Lead Registered Nurse, Advanced Illness

Company: Senior Care Action Network Foundation
Location: Long Beach
Posted on: February 23, 2021

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:

• Bachelor's degree in Nursing
• Registered Nurse required; Current and active California RN or PHN license in good standing.
• 3+ years of experience with comprehensive health assessments (physical and psychosocial); wound assessment and care; pain assessment; adherence to identified care plan; care coordination; health education; health promotion.
• Experience work with older adults and conducting home visits highly desirable
• Experience with mental health and/or substance abuse issues desirable.
• Proficient with EMR/EHR systems or similar functionality Ability to follow the identified plan of care and assist with coordinating a patents' care. Ability to identify/utilize resources, referrals such as Home Health PT/OT, Pharmacy, Dietary, DME, and other consults. Ability to provide counsel patients/families' of health education, health promotion, or provide emotional support as needed. Ability to work as a part of a team, while at the same time performing job independently. Experience educating families on non-pharmacologic management of dementia related behaviors. Hospice and/or Palliative Care Experience. Bilingual in English and Spanish or second language strongly preferred. Basic knowledge of related, CMS and DHCS regulatio
  • Travel potential 50% or more- in--Los Angeles, Ventura, Orange Counties and surrounding areas., must have CA driver's license with good driving record, proof of insurance, and reliable transportation. What's in it for you?
    • A competitive compensation and benefits program--
    • An annual employee bonus program
    • Robust Wellness Program
    • Generous paid-time-off (PTO)
    • Ten paid holidays per year, plus one additional floating holiday
    • Business Casual attire
    • A work-life balance and much more! We're always looking for talented people to join our team! Qualified applicants are encouraged to apply now! HealthCHEC is an equal opportunity employer and it is our policy to abide by all federal, state and local laws prohibiting employment discrimination. All qualified applicants will receive consideration for employment. Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor's legal duty to furnish information. 41 CFR 60-1.35(c)

Keywords: Senior Care Action Network Foundation, Long Beach , Lead Registered Nurse, Advanced Illness, Healthcare , Long Beach, California