Visiting Nurse- Facilities

Your Health Organization•Macon, GA

About The Position

Your Health is seeking a Registered Nurse to serve patients throughout the Tifton-area service region, including Tifton, Thomasville, and Moultrie. The Visiting Nurse, also called a Nurse Case Manager, is a key member of the patient care team. The nurse travels to patients’ homes and long-term care facilities, including assisted living and independent living facilities, to evaluate patients and initiate telemedicine visits. The role provides quality healthcare in accordance with applicable laws, regulations, policies, and scope of practice. This is a full-time, salary-based position with 8-hour shifts Monday through Friday, 8 a.m. to 5 p.m. Daily travel is required, and reliable transportation is necessary. On-call work may be required. Your Health is a physician group serving South Carolina and Georgia. It provides primary care, specialty services, and pharmacy support in care facilities, homes, clinics, and through virtual visits, working with facilities and families to deliver accessible, coordinated care.

Requirements

Must be a licensed nurse with a license in good standing with the appropriate board or issuer; a Registered Nurse is preferred.
A minimum of three years of clinical experience is preferred.
Community-setting experience is preferred.
Ability to communicate and collaborate effectively with interdisciplinary care teams, patients, and caregivers.
Strong written and verbal communication skills.
Basic computer knowledge.
Ability to manage responsibilities and demonstrate effective leadership skills and sound judgment.
Good interpersonal and communication skills under all conditions and circumstances.
Ability to foster a cooperative work environment and work as part of a team.
Ability to work flexible hours and travel between offices and facilities.
Must be a licensed driver with an automobile insured according to state and/or organizational requirements and in good working order.
Reliable transportation for required daily travel.

Nice To Haves

Registered Nurse credential.
At least three years of clinical experience.
Experience in community settings.

Responsibilities

Facilitate receipt of medical records from patients’ primary providers and specialists, and review the records.
Complete patient consents and enroll eligible patients in Care Management.
Initiate Care Management plans of care for eligible patients and work with the care team to keep plans up to date.
Capture diagnoses at the highest specificity by creating gaps and ensuring they are accepted.
Complete annual wellness visits for provider review, cognitive impairment screenings, and Social Determinants of Health assessments or screenings.
Complete advance care plans for review with patients by the provider.
Evaluate patients for home health, hospice, palliative care, specialty consultations, remote patient monitoring devices, and other resources or tools.
Communicate and coordinate care with patients, caregivers, providers, and the care team.
Reconcile prescribed and over-the-counter medications, vitamins, supplements, herbal remedies, and other treatments.
Provide post-discharge education.
Evaluate patients for adaptive equipment, durable medical equipment, and a safe environment.
Evaluate acute conditions and conduct follow-up evaluations after previous visits.
Document and log Care Management activities accurately.
Travel to patients’ homes and facilities to evaluate patients and initiate telemedicine visits.
Provide care in accordance with applicable laws, regulations, policies, and scope of practice.