Provides direct and indirect nursing care to PACE participants in clinic, home, telehealth, and telephone settings. Conducts assessments, administers medications and treatments, performs triage, coordinates care transitions, supports interdisciplinary care planning, educates participants and caregivers, and responds to emergencies. The RN also coordinates LVN and MA activities, documents care in Epic, supports quality improvement, enrollment, end-of-life care, and may provide after-hours on-call coverage.
Working under the supervision of the PACE Center Manager, the PACE Clinic RN is independent in the application of nursing knowledge and skills. Primary duties include direct and indirect nursing care to PACE Participants and operational support of the primary care clinic located within the PACE Center. The PACE Clinic RN works collaboratively with physicians, clinic staff, and other Interdisciplinary Team (IDT) members to manage ongoing care and complex clinical situations.
ESSENTIAL JOB FUNCTIONS:
- Conducts nursing assessments to determine PACE Participants’ care needs, preferences, and goals.
- Participates as an active member of the IDT for Participant care planning.
- Delivers and documents nursing interventions as agreed upon in the Participant’s care plan, including but not limited to maintaining a healthy and safe environment, promptly and accurately responding to primary care provider’s orders, and correctly administering medications and performing ordered tests and treatments.
- Remains alert to pertinent input from other team members, Participants, and caregivers and updates the IDT promptly regarding any changes in Participants’ condition or medical status.
- Works with the Participant’s assigned Primary Care Provider and other members of the IDT to manage smooth care transitions between settings (hospitals, skilled nursing facilities, home, etc.)
- Provides health education for the Participant, family, and/or caregivers regarding the disease process, self-care techniques, and prevention strategies.
- Supports enrollment of prospective Participants in the PACE program.
- Participates in end-of-life care coordination and support.
- Identifies medical emergencies and initiates appropriate response within scope of practice.
- Documents all nursing treatment accurately and within departmental time requirements into Participants’ electronic health record, documenting the delivery of all Participant care.
- Understands and demonstrates respect for Participants’ rights and utilizes established mechanisms for management of ethical issues in Participant care.
- Demonstrates active participation in Quality Improvement activities, staff training, and meetings.
- Provides care to Participants in-person, via telehealth, and/or via telephone, as indicated.
- Provides home health as needed.
- RN nursing level of triage.
- Coordinates and monitors the activities of clinical team members such as LVN, MA to ensure that clinical care is provided accurately, timely, and efficiently.
- Utilizes Epic appropriately and efficiently and serve as content and workflow expert for resolving issues and proposing solutions in Epic.
- Performs other job duties as required by Manager/Supervisor.
- May provide after-hours on-call coverage to support PACE participants when the PACE Center is closed as needed for support.
Required:
- Valid and current California RN license.
- Graduate of an accredited school of Nursing.
- Current BLS and First Aid required
Preferred:
- Bachelor’s degree or higher in nursing (BSN/MSN)
- Minimum of three years’ clinical nursing experience preferred.
- Certification in Public Health Nursing (PHN)
- Certification or additional training in geriatrics
- Minimum one year of experience working with a frail and/or older adult population
LANGUAGE:
- Must be able to fluently speak, read and write English.
- Fluency in Chinese (Cantonese) and/or Vietnamese is required.
- Fluency in other languages is an asset.
STATUS:
- This is an FLSA non-exempt position.
- This is not an OSHA high-risk position.
NEMS BENEFITS: Competitive benefits, including free medical, dental and vision insurance for employee, spouse and/or children; and company contribution to 401(k).
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