Visiting Nurse & Hospice Care is the leading home health and hospice provider in the Santa Barbara area, meeting the changing healthcare needs of our community since 1908.
Our mission is to provide high quality home health, hospice and related services to promote the health and well-being of all community residents including those unable to pay. As we grow and enhance our services, we are looking for top-quality individuals to help continue our legacy of excellence and our commitment to the community.
We are currently offering exciting opportunities to become a part of our committed team of skilled professionals in beautiful Santa Barbara County.
JOB DESCRIPTION SUMMARY
This in-office position assumes the lead role in coordinating the Telehealth Program, a subset of VNHC’s Cardiac Wellness Program. Responsibilities include patient education, daily assessment and evaluation of vital signs and weight for patients enrolled in the Telehealth Program. The Telehealth RN collaborates with Home Health Case Managers and Clinical Managers for strategies to resolve telemonitoring alerts including symptom management. The Telehealth RN performs optimally daily telephonic or video visits to educate patients with heart failure and other chronic conditions and ways of adhering to the treatment plan to avoid complications. The Telehealth RN provides guidance to these patients regarding self-management behaviors to improve their quality of life and to prevent hospitalization. The Telehealth RN also manages the remote monitoring of vital signs and weight for patients in the CenCal-VNHC Telehealth Program in collaboration with the CenCal nurse practitioner and medical personnel.
The Telehealth RN monitors quality indicators for patients enrolled in the Telehealth Program and other Home Health patients as directed. This includes chart audit for these patients and analysis of reason/s for re-hospitalization. Community outreach to promote telehealth is also a key role. The Telehealth RN respects and promotes the mission, values and vision of VNHC.
ESSENTIAL JOB DUTIES AND RESPONSIBILITIES
- Initiate daily telephonic or video visit for patients enrolled in the Telehealth Program.
- Prioritize patients to contact by phone based on information from the telemonitoring alerts.
- Using STOPLIGHTs and patient handbook specific for patients enrolled in the Telehealth Program, educate patients on symptom management and self-management behaviors ensuring teach-back and/or return demonstration is done.
- Document telephonic visits in patient’s electronic medical record on a timely basis.
- Assist the Case Manager to implement physician orders concerning changes in medications and vital signs parameters.
- Preserve the confidential nature of patient health information.
- Assure patient is able self-manage chronic disease/s, medications and lifestyle during the step-down phase of the Telehealth Program and prior to discharge from Home Health with or without the assistance of a caregiver.
- Assume responsibility for sending telemonitoring information to the physicians on a weekly basis.
COORDINATION OF CARE
- Coordinate Telehealth activities with appropriate personnel (Liaison, Intake staff, Scheduler, Home Health Aide/Technician, Case Manager) to ensure:
- Eligibility requirements for enrollment in the Telehealth Program are met
- Telemonitor is installed timely in the patient’s home
- Patient consent is signed on day of admission to the Home Health service
- Patient/caregiver telemonitor skills validation is completed by the field clinician or Telehealth RN
- Vital signs and weight are electronically transmitted successfully by the patient and field staff
- Telemonitoring alerts are responded to in a timely manner with appropriate notification to the physician when needed
- A PRN visit order from the physician is obtained based on patient’s changed or changing condition
- A PRN visit is done by the field staff whenever necessary
- Telehealth step-down phase is initiated timely, and criteria for the step-down phase are implemented
- Communicate and coordinate timely with the case manager/field staff concerning new and/or persistent telemonitoring alerts.
- Contact the physician as necessary.
- Provide brief telemonitor in-service with return demonstration to all new staff including information regarding Telehealth Program goals and objectives.
- Coordinate and collaborate with Quality staff in matters regarding quality outcomes, patient satisfaction and chart audit.
- Review the OASIS assessment performed by field staff for patients in the Telehealth Program and other patients as directed with the goal of maintaining OASIS accuracy.
- Monitor the quality indicators for patients enrolled in the Telehealth Program with the goal of achieving or exceeding national benchmarks.
- Perform chart audit for Telehealth patients and other patients as directed.
- Perform an analysis of reason/s for re-hospitalization and how hospitalization could have been prevented, in collaboration with the Home Health Case Manager and/or the Clinical/Rehab Managers and Quality staff.
- Provide the Director of Home Health, Quality staff and others various data/graphs pertaining to quality outcomes for patients enrolled in the Telehealth Program as requested.
- Participate in initiating staff education pertaining to continuous improvement in caring for patients enrolled in the Telehealth Program including appropriate OASIS documentation for this patient population.
- Promote the Telehealth Program to the community as directed.
- Based on Home Health needs, initiate routine patient visits as directed.
The above statements are only meant to be a representative summary of the major duties and responsibilities performed by incumbents of this job. The incumbents may be requested to perform job related tasks other than those stated in this description. All clinical staff are expected to participate as needed in variable shifts, including weekend rotation per staffing needs and departmental holiday rotation.
- Current and active California RN license.
- Bachelor’s degree, preferred.
- Minimum one year acute care experiencerequired.
- Experience in medical-surgical nursing, cardiovascular nursing and home care preferred.
- Current CPR certification.
- Licensed driver with insured automobile - in accordance with state and/or organization requirements.
- Excellent observation, verbal and written communication skills, problem solving skills, basic math skills; nursing skills per competency checklist.
- Ability to respond independently to life threatening situations.
- Ability to reason, deduce and carry out complex multiple step processes.
- Must be able to work in a fast-paced environment with demonstrated ability to effectively manage multiple competing tasks and demands with a positive “can-do” attitude.
- Must have high level of interpersonal skills to handle sensitive situations and maintain confidentiality.
- Must have knowledge of and be highly proficient in a variety of computer software applications including (but not limited to) Allscripts, Gmail/ZSentry, Microsoft Word and Excel.
- Must have strong data management, data analysis, and data presentation skills.
- Excellent proofreading and documentation presentation skills.
- Establishes priorities and meets deadlines.
- Excellent written/verbal and interpersonal communication skills
Job Type: Full-time
- acute care: 1year