Description
Performs initial on-site, comprehensive health assessments to determine personal care, behavioral care and/or home health aide needs, and develops appropriate care plans, while maintaining a reassessment caseload.
Ensure Preadmission Screening & Resident Review (PASRR) compliance for any assigned Community or CAE related screenings/assessments.
Reviews and completes Pre-Admission NF screening requests from affiliated hospitals/rehabilitation facilities and issues appropriate clinical decisions.
Works collaboratively with Care Manager?s as a consultant relating to clinical assessment, as well as review of consumer status for continued appropriateness of the care plan as consumer?s condition changes.
Develops and maintains effective relationships with service providers, hospitals and other community organizations in order to be cognizant of potential community resources.
Acts to both educate the consumer and caregiver in relation to the care plan, within the scope of practice and role of the ASAP RN, as well as an advocate to the consumer in response to their PC needs and goals.
Attends all required staff meetings, in-services, relevant outside training programs.
Performs and assumes other related duties/special assignments within the scope of the responsibilities of this position as requested by the Nurse Manager or the Director of Home Care.