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Home Based Nurse (PACE)

UPHAMS CORNER HEALTH CENTER
Boston, MA Remote Full Time
POSTED ON 2/18/2025
AVAILABLE BEFORE 5/12/2025

Job Details

Job Location

1140 Dorchester Ave. - Dorchester, MA

Position Type

Full Time 30 hours

Education Level

2 Year Degree

Travel Percentage

Road Warrior

Job Category

Health Care

Description

Position Title : Home-Based Registered Nurse

Department : PACE

Supervisor : Nurse Manager

Status / Hours Per Week : Non-Exempt / 40 hours

Primary Function :

The Home-Based Nurse provides initial and semi-annual nursing assessments for home-based participants; develops and implements nursing plan of care : provides medication management, daily nursing treatments, episodic assessments and nursing interventions at the home; collaborates with Primary Care to provide complete nursing services in a safe, secure, accessible environment with skill, dignity and respect; and completes scheduled / episodic nursing visits for Upham's PACE participants.

Duties & Responsibilities :

  • Complete initial and subsequent semi-annual nursing assessments.
  • Implement physician's orders, and document in medical record.
  • Develop and implement a nursing plan of care for each participant on case load.
  • Take responsibility for developing and implementing a medication management plan for each participant, i.e. implement physician's orders, order medications directly from pharmacy, document in medical record, assure administration of medication, provide education and training to participants and / or caregivers when needed to enhance adherence to medication regime.
  • Take responsibility for coordinating medication deliveries on a timely basis.
  • Complete scheduled / episodic skilled nursing visits.
  • Coordinate discharge planning with Center Nurse after ED visits, hospitalizations and nursing home stays.
  • Provide input in development of participant's individual care plan.
  • Maintain medical record documentation.
  • Act as member of inter-disciplinary team - attending morning meetings and weekly clinical meetings.
  • Participate in rotating on-call and weekend coverage.
  • Participate in program development and quality improvement activities.
  • Perform other duties as requested by Nurse Manager.

Qualifications

Minimum Basic Knowledge :

  • Skilled nursing interventions.
  • Ability to write and implement nursing care plans.
  • Computer skills for basic health care entry and documentation.
  • Solid verbal communication and writing skills in English.
  • Experience & Qualifications :

  • Licensed Registered Nurse in Massachusetts.
  • Minimum 1 year of experience working with geriatric population.
  • Must have a car to visit patients' homes.
  • Ability to work with participants, and caregivers.
  • Ability to work as a team member.
  • Bi-lingual language skills in Spanish, Portuguese, and / or Haitian Creole preferred.
  • Discharge planning experience desirable.
  • Independent Action :

  • Coordinate with participants, family members, and Upham's PACE staff, including HHAs, PCWs, and other vendors for service provision as required.
  • Provide continued education to home health aides, PCWs (Personal Care Workers) as needed.
  • Plan / schedule skilled nursing visits.
  • Supervisory Responsibility :

    None

    Define Access Level to PHI : Level 4 : Authorized to access full health information. UCC position and job responsibilities involve the provision of patient care and working as a clinical team member. Staff in this category level, although allowed full access, should only access the necessary information for each respective treatment encounter / circumstance.

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