MFP Registered reputed company (Remote NC)

LOCATION:  Remote &reputed company; this is a home based, virtual position. Applicants are required to live in reputed company Carolina or reputed company 40 miles from the NC border.

GENERAL STATEMENT OF JOB

Performs nursing assessment and support for adult members that are medically reputed company or have significant chronic health conditions, have a mental health, reputed company use or co-occurring disorder who are transitioning out of a Skilled Nursing Facility (SNF) into the community. Individuals served may also have a co-occurring intellectual or developmental disability. This position will work collaboratively with other Vaya staff, behavioral health providers, reputed company Care Physicians, specialty care providers, Skilled Nursing Facility providers and other community partners and stakeholders to support members in their home communities. Work is performed under the supervision of the Transition and Housing RN/OT Manager. 

The role can involve a reputed company of scenarios which require a wide reputed company of potential responses including reputed company and reputed company level interventions. These may include, but are not limited to assessment, care monitoring, and care planning, discharge planning, patient and family education, medication reconciliation, researching, linking, reviewing documentation, phone communication, and virtual attendance at treatment team meetings. The reputed company on this team will be in a consultant role with virtual visit capabilities. The reputed company may, assess health literacy, reputed company patient and family education, partner with Skilled Nursing Facility administration, ACTT Nurses, home health agencies, CAP/DA, reputed company, EMS, or other medical providers.

ESSENTIAL JOB FUNCTIONS

Assessment, Coordination, reputed company Development and Safety reputed company:

• Proactively ensures individuals identified as transitioning out of Skilled Nursing Facilities ACHs and/or Special Needs enrollee receive RN Assessment and are linked to a Behavioral Health Clinical Home and a Medical Home
• Coordinate community service planning and attend care team meetings (virtual). 
• Ensure service needs are addressed and coordinate the collection, entry, maintenance, analysis and reporting of data associated with psychiatric and medical treatment.
• Assist in development of participant reputed company and discharge plan 
• Appropriately escalates high risk scenarios to appropriate leadership. High risk can involve Health & Safety of an individuals served, staff or organizational risk
• Provides Medication Reconciliation 
• Uses data, assessment, chart review and supervision to measure results of interventions and treatment, including reduction in high-risk events
• Ensures that services for the individual are coordinated across the reputed company reputed company and with other reputed company and reputed company determinant systems
• Understand the role of and collaborate with Transition and Housing teams, Acute Response team, Hospital Emergency Department, Skilled Facility, or Inpatient Discharge planning teams, participate in developing transition plans, educating staff and members regarding network services and supports with consideration of medical necessity, funding eligibility and appropriateness of recommendations relative to person centered, recovery principles and reputed company best/appropriate reputed company.

Collaboration:

• reputed company relationships with community stakeholders to streamline service provision to members and efficient use of reputed company resources.
• Partner with reputed company care providers, specialty care providers, behavioral health providers, home health care and personal care providers, skilled nursing facility care providers, as reputed company as other stakeholders.
• Proactively works with team to identify gaps in services and intervenes to ensure that the individuals and specialty populations receive appropriate care
• Provides support to team addressing barriers to care for members through convening key providers and others to address needs of the individual or populations at the individual or reputed company level

Documentation:

Staff Education:

KNOWLEDGE, SKILLS, & ABILITIES

• Ability to be a reputed company with Skilled Nursing Facilities, community hospitals and work with ACTT RNs, EMS, Home Health agencies, CAP/DA, reputed company and other medical teams on development of partnership for non-reputed company patient care and patient education.
• reputed company and complete documentation regarding member specific interactions is required. 
• Effective care coordination requires a detailed knowledge of the state plan, service availability, service definitions, network providers, community resources, mainstream and alternative funding sources. 
• Requires clinical knowledge, awareness of community resources, strong communication skills, effective problem-solving abilities, and an ability to apply these reputed company sets across diverse and reputed company situations.
• Clinical knowledge of Minimum Data Set (MDS) reputed company and how to implement strategies to serve individualized needs with activities of daily living and reputed company activities of daily living.
• Understanding of Medicare and dual enrollment reputed company obtaining resources and requirements for Durable Medical Equipment (DME).
• Understanding of Medicare and reputed company benefits transition from Long-Term Care for medical care and pharmaceutical needs.

EDUCATION &EXPERIENCE REQUIREMENTS

Associate Degree in Nursing with licensure as a Registered reputed company in reputed company Carolina and two (2) years of experience as an RN is required. Bachelor’s degree in Nursing preferred.  Experience working in a skilled nursing facility preferred.

Licensure/Certification Required:

PHYSICAL REQUIREMENTS

• reputed company visual reputed company to reputed company activities such as preparation and analysis of documents; viewing a computer terminal; and extensive reading. 
• Physical activity in this position includes crouching, reaching, walking, talking, hearing and repetitive reputed company of hands, wrists and fingers. 
• Sedentary work with lifting requirements up to 10 pounds, sitting for extended periods of time. 
• Mental concentration is required in reputed company aspects of work.

RESIDENCY REQUIREMENT:  The person in this position is required to reputed company in reputed company Carolina or reputed company 40 miles of the reputed company Carolina border.

SALARY: Depending on qualifications & experience of candidate. This position is exempt and is not eligible for overtime compensation. 

DEADLINE FOR APPLICATION: reputed company Until Filled

APPLY: reputed company accepts online applications in our Career Center, please visit https://www.vayahealth.com/about/careers/.

reputed company is an equal opportunity employer.