Registered Nurse (Self Direction and Independent Living)
About The Position
Provide person-centered nursing guidance, health coordination, education, and clinical oversight for people supported through AIM’s Self Direction, Independent Living, and Housing Initiatives. Help each person identify and manage health-related needs while living independently, primarily through Self Direction. Work in partnership with the person, their circle of support, and the Independent Living and Housing Initiative team to promote informed choice, independence, safety, and successful community living. Responsibilities include nursing assessment, education, medication-related support, individualized planning, and in-person or telehealth follow-up based on each person’s needs and preferences. The RN recognizes that each person directs their own life and services to the greatest extent possible. Nursing recommendations should be explained in accessible language, reflect the person’s goals and preferences, support informed decision-making, and preserve the person’s authority over their home, schedule, providers, and self-hired staff. Information is shared with family members and other supporters only as authorized by the person or otherwise permitted by law. The position reports to the Director of Independent Living and Housing Supports, with clinical supervision and consultation from the Director of Clinical Services or designee.
Requirements
- Current, valid New York State RN license.
- At least one year of nursing experience involving community health, care coordination, medical-surgical nursing, home care, developmental disabilities, or another setting relevant to supporting people with complex health needs in the community.
- Ability to provide nursing support in a person-directed, community-based model; respect informed choice and dignity of risk; communicate clinical information in accessible language; collaborate with self-hired staff, families, Care Managers, Support Brokers, Fiscal Intermediary staff, and community health care providers; and balance independence with individualized health and safety safeguards.
- Flexibility with schedule to support the needs of the people served.
- Strong organizational skills, including the ability to prioritize and multitask; attention to detail.
- Excellent verbal and written communication skills.
Nice To Haves
- Valid New York State driver’s license acceptable to agency insurance standards. If using a personal vehicle, maintain valid insurance and provide the insurance card.
Responsibilities
- Work with each person and their circle of support to address health conditions, medications, functional abilities, communication needs, self-management strengths, required support, and health-related goals and preferences; develop recommendations and plans with the person and their chosen team, and follow up when needs or circumstances change.
- Support each person’s health through an individualized combination of visits, telehealth contacts, record review, and communication with authorized members of the person’s support team, based on assessed needs, challenges, preferences, and applicable requirements.
- Evaluate and support assistive technology, remote supports, medication reminders, electronic health tools, accessible communication systems, and other technology that may increase independence or health-information access and reduce reliance on paid support; identify options with the person and their team, provide education and training, monitor effectiveness, address privacy and safety, and adjust supports as needed.
- Provide education, competency-based training, clinical guidance, and ongoing support to self-hired staff and other authorized supporters as requested, including on medication administration, delegated nursing services, diabetes care, skin integrity, positioning, mobility equipment, and person-specific needs.
- Support the person and, when requested, authorized team members with scheduling, preparing for, attending, and following up on medical appointments, with RN involvement reflecting the person’s preferences, assessed needs, and available supports.
- Build the person’s skills and confidence in managing health, including understanding conditions, communicating with providers, scheduling appointments, recognizing changes, obtaining refills, organizing medications, and safely self-administering medication when appropriate; assess abilities and accommodations, provide accessible education and skill-building, and periodically evaluate progress with the person and their chosen team.
- Coordinate medical and health information with family members, health care providers, and outside agencies as authorized by the person or otherwise permitted by law; share only information necessary for coordinated care, informed decision-making, and continuity of services.
- Collaborate with the person and their team to develop and maintain individualized health and safety plans covering changes in condition, urgent and emergency situations, medication concerns, unavailable staff, hospital admission and discharge, and continuity of essential supports.
- Ensure self-hired staff and other authorized supporters understand their responsibilities, available resources, and when to contact a health care provider, 911, or another identified emergency resource.
- Provide direct support as requested or required.
- Ensure compliance with applicable state, federal, and agency policies and procedures.
- Participate on committees as assigned or needed.
- Perform other related duties as requested by the supervisor.
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What This Job Offers
Job Type
Full-time
Education Level
No Education Listed
