Homebound Outreach & Quality Nurse / RN - Full Time

About the Role

We are seeking a Homebound Outreach and Quality Nurse to join our team at East Liberty Family Health Care Center, a faith-based Federally Qualified Health Care Center serving the East-End section of Pittsburgh, PA. Our mission is to provide quality healthcare to the underserved, underinsured, and uninsured. This role involves providing nursing services to homebound patients and telephonic case management for patients with multiple chronic conditions. Bilingual candidates (English/Spanish) are strongly encouraged to apply. COVID and influenza vaccines are required.

Qualifications

• RN degree and current State Nursing Licensure.
• 3 years of Home Care experience required.
• Geriatric nursing experience and MD office experience preferred; Behavioral Health experience is a plus.
• Valid Driver's License, insurance, and ability to commute to patient homes for visits.
• Knowledge of Electronic Medical Records documentation and management (eCW knowledge a plus).
• Working knowledge of CMS Chronic Care Management and community-based resources is a plus.

Responsibilities

• Screen physician referrals to the Homebound Program and evaluate patient needs.
• Update patient demographics, consents, sliding fee scale, contacts, and insurance information.
• Evaluate and discharge patients from the Homebound program based on program criteria.
• Implement and track the Chronic Care Management Program for clients.
• Develop and follow care plans using the Chronic Care Module.
• Visit patients in their homes, record vital signs, manage medications, and perform laboratory testing per standing orders.
• Assist with monitoring and scheduling Transitional Care Management (TCM) patients.
• Triage and respond to phone messages according to protocols.
• Monitor practice performance according to HRSA UDS, Patient Centered Medical Home, and Health Plan quality standards.
• Identify patients overdue for preventative screenings and perform chart reviews and audits.
• Assist in preparing reports for QI/QA Committee, Leadership Committee, Practitioners, and Nursing Staff meetings.

Benefits

• Medical, Dental, Vision, and Life Insurance.
• Retirement plan and Employee Assistance Program.
• Holiday pay, Paid sick/vacation, and numerous supplemental benefit options.

Position Details: Full-time, 40 hours per week. Compensation is commensurate with education and experience. Bilingual candidates (Spanish/English) are encouraged to apply.