Registered Nurse- PACE

TriHealth•Norwood, OH

7d•Hybrid

About The Position

The PACE Registered Nurse (RN) is a member of the PACE Interdisciplinary Team (IDT) and is responsible for completing nursing assessments for new PACE participants and nursing reassessments for existing PACE participants as part of the PACE IDT care planning process. The PACE RN provides general and skilled nursing care to participants, executes nursing interventions in accordance with the plan of care, implements primary care orders, evaluates participant conditions in the PACE clinic and by telephone, and develops appropriate PACE nursing plans of care. The PACE RN provides nursing education to participants, caregivers, and PACE staff. The PACE RN provides nursing care in the PACE Clinic and as needed in the participant homes.

Requirements

Bachelor's Degree - Nursing Graduate of an accredited School of Nursing (Required)
Registered Nurse Current RN license in good standing to practice in Ohio Upon Hire Required
BLS BLS Required

Responsibilities

Participates as a PACE Interdisciplinary Team (IDT) member and is responsible for completing comprehensive initial nursing assessments for new PACE participants and nursing reassessments on existing PACE participants as part of the PACE IDT care planning process.
In collaboration with the primary care provider and IDT, develops and implements nursing care plans for participants, identifying and considering the medical, physical, social, and emotional needs of PACE participants.
Works collaboratively with the primary care provider, and within the RN’s scope of practice, initiates nursing interventions independently, triages PACE participant nursing needs in the PACE Clinic or a community setting, and escalates any nursing concerns to the primary care provider and IDT.
Promptly responds to primary care provider orders requiring nursing interventions, promptly documents nursing interventions in participant care plans and in the PACE Electronic Health Record (EHR), and administers participant medications in the PACE Clinic as needed.
Reviews, signs off, and disseminates orders and instructions to appropriate PACE staff and PACE contracted personnel. Maintains and reviews participant records, charts, and other pertinent information as needed. Completes nursing documentation in the PACE EHR in accordance with the federal PACE regulation and organizational policy.
Provides case management and care coordination during care transitions and proactively communicates with hospital and long-term care facility case managers regarding participant discharge care plans.
Monitors PACE participants for changes in their health or psychosocial status requiring a nursing reassessment. Promptly communicates pertinent changes in participant status to the IDT. Attends IDT and morning meetings and reports on participants’ clinical status. Participates in the nursing on-call rotation to provide after-hours and weekend call coverage to PACE participants. Supports the PACE QI program and participates in PACE QI activities as assigned.