The Home Visiting Nurse (HVN) is a professional nurse who coordinates and directs the home care patient's care based on individual patient needs. The HVN is responsible for independent management of the homebound patient requiring the use of advanced assessment, teaching and decision-making skills. This role focuses on improving quality of care /continuity of care and reducing utilization costs by providing complex wounds, are high risk, and need complex treatment protocols. The High-Risk Nurse provides direct clinical care in the home for select GMG Managed Care Patients. This nurse provides clear feedback in a timely basis to the Wound Care Specialist, Primary Care Physician (PCP), and/or other pertinent providers on the case.
Why Gonzaba Medical Group-What makes GMG "unique"
Our purpose and drive are to create a healthy company where our physicians and staff share a collective passion for enhancing the health of our community. Our culture, como familia-like family, is the foundation for a patient-centered medical home where everyone in our community can get easy access to superior care.
Culture- We are Physician-Led, engaged employees who live the culture and values; internal support centers who embrace the culture; we are not lean in clinical staff.
Legacy- We are proud of serving more than 60 years of multi-generational care; community relationships; family owned; we are from San Antonio not out of state.
Our Model of Care- Coordinated Care Model (full risk capitation funding); Wrap-around, innovative care approach (urgent care, radiology, biopsy lab, high risk, etc); unique approaches to clinical training
What you can expect day to day
Coordinates with Physicians and other individuals to establish patient care plan.
Provides clinical care to High Risk or high-cost patients in their home, to include Patient assessment, wound care, wound vacs, IV antibiotics, medication reconciliation, and other skills as determined by ordering physician.
Assesses and evaluates patient/client's status, reviews, and implements plan of care, re-evaluates needs, and revises plan of care as necessary. Observes patient for changes in condition and communicates/coordinates care with physician and clinical management. Maintains an updated clinical record on each patient at all times, meeting required deadlines for documentation of certification, re-certification, aide supervision reports, aide care plan updates, routine recording of case coordination, care plan updates, addressing progress toward goals, and verbal orders.
Communicates clearly and effectively with other home visiting Nurses, Case Management, and other members of the Care Team. Works effectively with team to provide same day care to patients when the need arises.
Provides ongoing nursing assessment with the patient, family, and home environment to determine physiologic or psychosocial risk. Applies previous nursing experience and base of knowledge and adapts with the patient and family in a home setting.
Organizes time, talents and supplies on hand wisely to see patients in the most efficient and effective manner.
Contacts patient and schedules time of visit, confirms appointment day prior to the visit.
Provides education to patients and families on proper home health care procedures and strategies.
Exercise tact and courtesy when dealing with patients, visitors, physicians, and co-workers.
Rotates through a cycle of providing on-call coverage with dept is closed to include weekends, and holidays.
Maintains productivity according to agency standards after first 3 months of employment.
Provides care in a geographically logical manner by reading and updating directions to home in the medical record and using map reading skills.
Acts to facilitate cost control in scheduling home visits according to geographic location.
Uses technology effectively to support nursing practice and create efficiencies in care delivery.
Maintains consistent availability throughout the workday, responding to Dept office communications via E-mail, voice mail, within expected timelines.
Ensures confidentiality of all member health information.
Able to work effectively under pressure.
Other duties as assigned.
What it takes
Education and Experience: Graduation from an accredited nursing program; Must be state licensed as a registered nurse with a minimum three year of experience, outpatient clinic experience preferred. Prior managed care experience preferred. The Nurse must have knowledge medical terminology, understanding of ICD-9 coding; must have excellent customer service skills. Knowledge regarding quality improvement and home health standards of care. Experience in teaching both patient and family's self-care skills. Knowledge regarding the impact of acute and chronic illness on the lives of patients and families in the community. Functions with a high degree of independence. Collaborates with other disciplines to provide care.
Licenses/Certifications: Current RN License through the state of Texas. Certification in Wound Care is preferred. IV/PICC/Central Line certification is required within a month of hire. Valid Texas Drier's License and current car insurance. CPR Certified.
Computer Skills: Strong Basic Computer skills. Knowledge of Word Processing software, database software, spreadsheet, and Internet software. Knowledge with working with an Electronic Medical Record.
Supervisory Responsibilities: This job has no supervisory responsibilities.
Work Environment: Depending upon the area assigned, may be 100% clinical setting or office setting in a clinical environment. There may be exposure to communicable diseases, bodily fluids, toxic substances, ionizing radiation, medicinal preparations, and other conditions common to a clinic environment.
Physical Demands: Requires manual dexterity, sitting, standing, stooping, reaching, kneeling, crouching, bending, walking, and lifting up to 40 lbs. Close vision and ability to adjust focus.
The above job description is not intended to be an all-inclusive list of duties and standards of the position. Incumbents will follow any other instructions, and perform any other related duties, as assigned by their supervisor. Reasonable accommodations may be made to enable otherwise qualified individuals with disabilities to perform the essential functions of the job.
3 year(s): Outpatient Nursing Experience
Associates or better in Nursing or related field
Licenses & Certifications
Team Player: Works well as a member of a group
Detail Oriented: Capable of carrying out a given task with all details necessary to get the task done well
Enthusiastic: Shows intense and eager enjoyment and interest
Dedicated: Devoted to a task or purpose with loyalty or integrity
Self-Starter: Inspired to perform without outside help
Ability to Make an Impact: Inspired to perform well by the ability to contribute to the success of a project or the organization