Homebound Nurse - Chronic Care & Outreach (Bilingual)

East Liberty Family Health Care Center; Pittsburgh (Allegheny County); On-site; USD 70,000 - 90,000; Full time

Benefits offered by this job

Medical benefits

Dental benefits

Retirement plan

Paid time off

Job summary

East Liberty Family Health Care Center is seeking a Homebound Outreach and Quality Nurse to deliver nursing services to Homebound patients and provide telephonic case management for those with chronic conditions.

Qualified candidates who are bilingual in English/Spanish are strongly encouraged to apply; the role requires travel to patient homes in the East Liberty/Lincoln-Lemington areas of Pittsburgh.

Qualifications

• RN degree and current State Nursing Licensure.
• 3 years Home Care experience required.
• Geriatric nursing experience and MD office experience preferred; Behavioral Health experience is a plus.

Responsibilities

• Screen physician referrals to the Homebound Program.
• Screen patient charts and update demographics including consents, sliding fee scale, contacts and insurance.
• Evaluate patient's ongoing need for Homebound services based on program description.
• Discharge patients from the Homebound program according to discharge criteria.
• Learn and implement the Chronic Care Management Program for ELFHCC Clients and track time.
• Develop care plans and goals for clients and follow appropriately using the Chronic Care Module.
• Visit patients in their home, take and record vital signs, obtain specimens, manage medications and perform laboratory testing per standing orders.
• Triage and respond to phone messages according to phone protocols. Document all calls before the end of the day.
• Monitor practice performance according to HRSA UDS, Patient Centered Medical Home and Health Plan quality standards, including programs for unconfirmed diagnosis codes and quality measures/gaps in care.
• Use reports available within the EMR as well as information obtained from Health Plans to identify patients who are overdue for preventative screenings.
• Perform chart reviews and audits (HRSA UDS, ELFHCC Peer Review, HEDIS, Health Plans, etc.).
• Assist in the preparation of reports for the QI/QA Committee, Leadership Committee, Practitioners and Nursing Staff meetings.

Education

RN degree

State Nursing Licensure

Tools

eCW knowledge

Job description

East Liberty Family Health Care Center is seeking a Homebound Outreach and Quality Nurse to deliver nursing services to Homebound patients and provide telephonic case management for those with chronic conditions.

Qualified candidates who are bilingual in English/Spanish are strongly encouraged to apply; the role requires travel to patient homes in the East Liberty/Lincoln-Lemington areas of Pittsburgh.