RN / Registered Nurse / Oregon / Assignment / Nurse- Pmg At Home Field Nurse - 5,000 Sign On Bonus J. Job in Portland Care Jobs

Shift schedule is 8am to 5pm M-F.You will see patients in NW Portland, Beaverton, Aloha, Hillsboro, Lake Oswego.$5,000 Sign-on Bonus for eligible rehire and external candidates who meet all conditions for payment - this is in addition to the fantastic benefits and compensation package offered by Providence that begin on your first day of employment.We are seeking a PMG at Home Nurse - Pmg At Home In this position you will have the following responsibilities:Utilization ManagementUse a systemic process and clinical skills to assess, plan, implement and evaluate an individual plan of care for a patient that spans the continuum of care. The plan of are is developed in conjunction with the Primary Care Provider, the patient and the patients family or caregiver(s)Use principles of utilization management in the decision-making process to assure both quality and cost-effectivenessDemonstrate the ability to utilize regional population risk stratification information and processes to identify appropriate members for enrollment into case management for complex longitudinal care in collaboration with clinicians and other members of the PMH health care teamNursing Assessment, Screening and TriageComplete assessments for fragile, at-risk patients and gathers essential information needed for plan of careUpdate assessments in collaboration with the patient, family and/or caregiver, identifying changes in patient conditions and progress towards desired patient outcomesPrioritize urgent patient/family/caregiver needs utilizing screening tools from relevant sourcesPerform hands on nursing care as needed based on patient diagnosis and acuityTriage calls from existing patients/families/caregivers, addressing clinical issues and forwarding information to health care team members as neededIncorporate medication review and management into all assessments, integrating pharmacy as neededEvaluate patient/family/caregiver psychosocial, spiritual and physical needs. Communicates needs to appropriate health care team members, as neededCare CoordinationProvide coordination of carePrioritize findings from member assessments, identifying patients needs and potential issues and/or barriers to careEngage patients to define and set patient centered goals as part of the plan of care and appropriate level of self-management, and interventionsDevelop and document a patient-centered care plan that addresses patient-centered goals that are specific, attainable and measurable in collaboration with patients and family membersDocument ongoing follow up and monitoring of effectiveness of the interventions and reinforce the treatment planAdvocate and provide care coordination and management services for patients with identified needsAct as a liaison with other members of the PCMH teamInform the providers, members of the health care team and other parties as indicated of changes in the patients conditions and needsManage a nursing caseload that includes patients requiring a broad spectrum of care, who reside in a variety of environments and in a wide geographical area by practicing good organizational and time management skillsCollaborate with other agencies as needed, including Home Health and HospiceTeachingTeach, supervise and counsel patients and caregivers on patient care in accordance with the patient and family wishes, beliefs, communication styles and valuesParticipate as preceptor in the orientation of new staff and/or students as assigned by supervisorDevelop and distribute health literate education, tools, and materials for patient careQualityTarget reduction in unnecessary readmissions or ED visits, improvement in patient experience and health outcomes by appropriate management of urgent clinical issuesMonitor and reassess the plan of care to ensure that quality, quantity and goal achievement are appropriate and cost effectiveContribute to ongoing process improvement including related procedures, policies, and patient support and documentation toolsPMG at Home Nursing Team FunctionsRotate schedule through weekends and holidays as assigned by supervisor.Perform procedures and treatments according to accepted organizational and department policies and standardsMaintain patient clinical records according to accepted organizational and department policies and standardsOther duties as assignedQualifications:Required qualifications for this position includes:Current, unencumbered state of Oregon RN licenseAmerican Heart Association Basic Life Support for Health Care Provider completion required within one (1) month of hireA valid driver's licenseDriving record consistent with GOP Safe Driving Policy 330 Incident Point Matrix at time of hireTwo (2) years of Clinical medical-surgical, acute care or long-term care experience that includes:One (1) year community-based/ambulatory careOne (1) year in care of the frail elderlyPreferred qualifications for this position includes:Bachelor's Degree in NursingCurrent recognition by a national professional organization in case managementCase Management Society of America (CSMA) CCM credential.American Case Management Association (ACMA) ACM credentialAmerican Nurses Credentialing Center (ANCC) RN-BCNine (9) months of Home health, hospice, palliative care, managed care, -OR- skilled nursing facility backgroundOne (1) year of Care management of diverse patient populations