Overview:
We have a variety of RN/LPN openings available in Miami-Dade and Broward Counties and are excited about matching you with a great opportunity! As a Heavenly Touch Home Health Care RN/LPN you will provide skilled nursing care for patients in their place of residence, coordinate care with the interdisciplinary team, and assume the responsibility for coordination of care. Maintain compliance with our agency’s policy and procedures and Medicare regulations. Educate patient and caregiver(s) on techniques for home health care. Notify the physician and/or other personnel of any change(s) in the patient’s condition and case conference clinicians providing care to ensure coordination of care. As part of our team, you are required to attend staff meetings, as well as complete annual in-services hours.

Qualifications:

• One (1) year direct patient care experience in a clinical care setting, home health setting and/or hospice setting.
• Good documentation skills required.
• Ability to travel per job requirement.

Requirements:

• High school graduate or equivalent.
• State license as a Registered Nurse (RN) or Licensed Practical Nurse (LPN)
• CPR Certification
• AHCA Background screening
• 12 hours of In-Services / CEU's

Job Types: Full-time, Part-time, Per-Diem

Pay: $18.00 - $30.00 per hour

overview
Required skills & experience:
1) Graduate of an accredited School of Nursing.
2) Currently licensed as a Registered Nurse in the State of TX (or other NLC state).
3) 2+ years previous experience working in care management and/or with CKD/ESRD patients is preferred.
4) Ability to take call remotely on some nights and weekends
5) Must have Home Health and/or Hospice experience.


What You Need to Know:
1) Opportunity to work in a dynamic, fast paced and innovative care management company that is transforming the delivery of kidney care.
2) Competitive compensation package including salary and bonus.
3) Flexible paid leave and vacation policy.
4) This position is in-and-around metro Dallas, TX.
5) This position will work with underserved populations.
6) Laptop, mileage reimbursement, phone allowance, and extra perks available!

Additional Job Details:
1) Develop and continually adapt an individualized care plan in conjunction with Monogram physicians
2) Perform frequent daily in-home care management visits to execute care management plans
3) Serve as the primary point of contact and be the first call when members have questions about their health
4) Prepare care recommendations and escalations for plan members, write reports regarding the same and communicate the same in weekly internal case rounds
5) Understand the needs of Monogram health plan managed care clients and prioritize plan member visits, recommendations and focus accordingly
6) Use personal communication skills, patience and diligence to engage plan members and their caregivers
7) Perform post-op and hospital discharge visits to help plan members through vulnerable transitions
8) Review and document plan member updates and progress in care management platform
9) Monitor biometric data and follow approved protocols for any necessary interventions
10) Inventory and reconcile medications and coordinate with pharmacists and prescribers
11) Perform plan member health assessments and surveys as required
12) Deliver individual and group education on CKD, ESRD, dialysis and associated comorbidities
13) Encourage medication and treatment adherence through frequent contact with members
14) Engage positively with Monogram social workers to facilitate social and behavioral needs to of plan members
15) Educate members and facilitate conversations around proactive care decisions, especially relating to transplantation, home modalities and proactive AV fistula placement
16) Coordinate with dialysis providers to ensure transitions of care are seamless
17) This is a care management position, in which Care Manager – RNs will create and administer care plans, rather than rendering direct clinical services. Care Managers – RNs lead the effort to help prevent costly and traumatic episodes such as avoidable hospitalizations, readmissions, and unexpected kidney failure. For those already on dialysis, Care Managers – RNs provide additional support, particularly around transitions in care such as hospital discharges.

Home Care Staff Nurse

The Home Care Nurse Provides all nursing functions according to Massachusetts Law and HHSI policy and procedure and is responsible for medical case management of home-based participants, providing home health services to geriatric clients of the Elder Services Plan while building a trusting relationship with the clients. 
 
Job Duties:
• Performs routine clinical nursing duties, including history taking, vital signs, administration of medications, dressing changes and other nursing procedures under the verbal or written order of a provider as prescribed by law, written clinical policies and within the limits of his/her own license and training.
• Responsible for Case Managing home based clients through communication with providers, center nursing staff, specialists, Clinical Nurse Manager, Clinical Director and all other ESP staff members involved in participant care.
• Completes nursing assessment and collaborates in the development of a comprehensive plan of care, as required by the Patient Care Team.
• Triages patients’ regarding illness and medical therapy and advises the patient/caregiver of the most appropriate action in consultation with a provider whenever necessary.
• Interacts with Clients and family members in a manner that adheres to the highest standards of care and professionalism.
• Builds trust and fosters smooth relationships with Clients and their families.
• Promotes patient confidentiality and right to privacy.  
• Establishes and maintains, via provider order, an ongoing case management system that includes but is not limited to contracting patients with abnormal lab results or who fail appointments in accordance with Agency policies.
• Provides health teaching using appropriate information on health maintenance and disease management during each patient encounter according to Agency policies.
• Continuously updates his/her own clinical and professional knowledge and skills through formal and informal educational experiences.



 
Required/Preferred Education, Experience and Skills:
 
• Current MA RN License and Basic Life Support (BLS) required. 
• Two (2) or more years of experience in a home care, professional or business environment.
• One year of experience working with geriatric patients.
• Must be able to travel in a timely manner to participant's homes in the Brockton and surrounding area. 
• Excellent communication and customer service skills.
• Excellent critical thinking, problem-solving and organizational skills.
• Computer literacy (Microsoft Office applications with a focus on Word, Excel and Outlook).
• Experience with medical computer scheduling preferred.
• Community health or ambulatory care experience preferred.
 

• Performs routine clinical nursing duties, including history taking, vital signs, administration of medications
• Dressing changes and other nursing procedures under the verbal or written order of a provider as prescribed by law, written clinical policies and within the limits of his/her own license and training.
• Responsible for Case Managing home based clients through communication with providers, center nursing staff, specialists, Clinical Nurse Manager, Clinical Director and all other ESP staff members involved in participant care.
• Completes nursing assessment and collaborates in the development of a comprehensive plan of care, as required by the Patient Care Team.

• Associate Degree in Nursing
• Current MA RN License
• CPR Card
• Two (2) or more years of experience in a home care, professional
• One year of experience working with geriatric patients.

• Monday-Friday 8AM-4:30PM

• $32.00-$41.00 DOE

Nursing Assistant Responsibilities

• As a Nursing Assistant you will help a small group of elders in their daily routines.
• Prepare the elders to get dressed to go out. Escort elders to our vans. The vans drive the elders to our centers, which have a medical clinic and social center.
• The Nursing Assistant will help the elder move from their bed to a chair or a wheelchair. Help them walk, sometimes with a cane or walker.
• Let your supervisor know when the elders need food, medicine, or personal products.
• The Nursing Assistant will follow the care plan to complete tasks for your elders.
• The Nursing Assistant will call the Home Care Nurses when there are changes in an elders' health or emotional state. Call this nurse if there is a change in the elders' needs, or something urgent happens.
• We will schedule your daily assignments. If there is a change to the schedule, the staffing coordinator will call you.

   

  As a Nursing Assistant you must meet these requirements

• A valid Certified Nursing Assistant license
• High School Diploma or GED or 2 years of relevant work experience.
• CPR certificate and First Aid certification. These must be up-to-date.
• You understand basic English, can understand instructions, and write simple sentences.

   

  We are looking for CNAs/Nursing Assistant who have:

• A good work history, with good attendance and being on-time.
• Experience caring for older adults, some of who are frail and have dementia.
• Experience doing light house cleaning, consistently and efficiently.
• Can follow directions with limited supervision.
• Good people skills, and a helpful attitude.
• Can keep good, accurate records of your work
• Billingual is a plus