Position Summary: The AFC Program Nurse is responsible for conducting the initial medical assessment of the prospective program participants, as well as maintaining communication with client’s medical team. In addition, this person is responsible for indentifying and accessing additional medical resources to support and to assist clients and their families in his/her caseload, and for maintaining direct communication with the AFC Program Director. Duties & Responsibilities: Completing the MDS-HC or CDS and other nursing assessments and coordinating all other applicable clinical assessments; Developing and reviewing on an ongoing basis each member’s AFC plan of care; Selecting, training, evaluating, and supervising AFC caregivers in conjunction with the care manager; Reviewing the physician summary; Monitoring the health status of all members to ensure that all needed AFC is properly delivered; Reporting changes in the health status of any member to the member’s physician; Periodically reviewing AFC caregiver logs; Conducting on-site visits with each member at the qualified setting bimonthly (alternating with the bimonthly visit by the care manager) for Level I and Level II, and monthly or more often as the member’s condition warrants. Completing a nursing progress note corresponding with each on-site visit or encounter, or more often as the member’s condition warrants; Submitting a semiannual health-status report to the member’s primary care physician; Planning for and implementing discharges from the AFC program; Conducting an orientation for each AFC caregiver before the AFC caregiver begins personal care; and Providing ongoing training to AFC caregivers on health and aging. Medical Intake & Assessment and Service Plan: In collaboration with appropriate collateral and family members, the AFC Nurse is responsible for conducting a medical assessment of the prospective client, and establishing a medical plan with goals and objectives. Mandated Reporter Statute : An individual in this position is considered a “Mandated Reporter” when on, or off duty according MA Statutes.
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Job Type
Part-time
Education Level
No Education Listed