RN Assessment Nurse- Monroe County

HCR Home Care•Rochester, NY

3d•$77,000 - $96,000

About The Position

The RN Assessment Nurse conducts patient assessments in accordance with the Home Assessment Abstract, DMS-1, and physician’s orders. The role includes initial patient assessment and agency admission, coordinating the Start of Care process, and delivering and coordinating quality, patient-centered care. The nurse collaborates with physicians, case managers, care providers, and other disciplines to develop and implement individualized plans of care, support safe patient outcomes, educate patients and families, and supervise Home Health Aides and Personal Care Aides. The nurse must comply with New York State nursing regulations, applicable infection-control standards, documentation requirements, and agency guidelines. The position is primarily performed in a non-office setting and may involve exposure to outdoor conditions. Working conditions are classified as medium work, involving sitting and standing and occasionally exerting up to 50 pounds of force. The role regularly requires standing, sitting, hearing, walking, talking, stooping or kneeling, and repetitive motion.

Requirements

Graduate of an accredited school of nursing.
Current, valid Registered Nurse license issued by the New York State Department of Education.
At least one year of Home Health Care experience, specifically with OASIS-C.
Demonstrated effective teamwork.
Demonstrated ability to resolve immediate patient problems effectively before transferring them to the Care Delivery Team.

Responsibilities

Conduct initial patient assessments and agency admissions using a patient-centered approach.
Coordinate the Start of Care admission process through timely, accurate communication and establish trust and respect with the receiving care provider team.
Practice within the scope of a Registered Professional Nurse under New York State regulatory guidelines.
Understand responsibility requirements and various insurance plans.
Complete and submit all required documentation accurately and within agency standards and guidelines.
Provide and coordinate quality, patient-centered care while maintaining productivity.
Obtain medical history from the patient and/or designated caregiver, with particular attention to the present condition.
Conduct comprehensive assessments, including vital signs and physical and mental status.
Use critical thinking and collaborate with the physician to make clinical decisions that support safe, effective, efficient, high-quality care.
Observe and assess adverse findings and promptly report them to the physician, including treatment reactions, medication interactions, and changes in physical or emotional status.
Implement physician orders, nursing procedures, and nursing interventions using competent nursing skills, knowledge, and judgment.
Develop and implement a safe, realistic, individualized Plan of Care in collaboration with other services and disciplines.
Evaluate the patient, family, and home situation to identify teaching needs and support the patient’s health goals.
Initiate education for patients and families based on identified learning needs related to home care and the professionals and paraprofessionals involved in care.
Evaluate the home environment, available family and other support, and whether a safe plan of care can be implemented at home.
Foster open communication and collaborative practice.
Plan, teach, supervise, and counsel on physical care measures, health improvement, symptom management, disease complications, expected disease progression, and community resources.
Follow accepted nursing standards for infection control.
Promote a positive work environment and attitude, provide excellent internal and external customer service, and support teamwork and collaboration with other disciplines.
Remain flexible and responsive to workload changes.
Communicate with the patient’s Case Manager about the plan of care, patient needs and goals, and purpose of assigned visits.
Develop an appropriate patient plan of care for HHA/PCA services and evaluate the care provided by HHAs/PCAs.
Document services rendered; changes in the patient’s condition or family situation and related reporting; progress toward goals; communication with the care team and physician; interim medical orders; visit reports to the case manager; and return demonstrations by patients or caregivers.
Perform other duties as assigned.