ProCARE Plus Registered Nurse

The ProCARE+ Registered Nurse (RN) occupies an important role in providing wrap-around service to patients, thereby contributing to optimized clinical outcomes and deeper patient engagement and satisfaction.  The ProCARE+ RN provides or directs provision of virtual nursing care as prescribed by the physician/provider and in compliance with applicable laws, regulations, and agency policies.  Utilizes technology to facilitate synchronous and asynchronous virtual contacts with patients, expanding how patients are monitored, educated, and supported throughout their healthcare journeys.  Collaborates closely with the patient and/or caregivers, clinicians at the agency, physicians/providers, and other health care professionals to deliver and maintain continuity around the total plan of care.   

• Monitors and assesses patient’s health status via use of telehealth equipment in the patient’s home, patient feedback via survey responses and text/email, or audio-visual contacts and virtual skilled nursing visits.
• Recognizes changes or trends in a patient’s health status or derivations from patient-specific parameters; intervenes as indicated by the patient’s condition and established protocols. 
• Demonstrates proactive patient care management leveraging strong base of clinical knowledge and excellent critical thinking skills to enact evidence-based best practice guidelines, thereby reducing risk of exacerbations and complications. 
• If possible, works to resolve issues that are assessed, including contacting the physician/provider to report concerns and obtain new/clarified orders; documents orders in the medical record and communicates them effectively and timely to agency clinicians to ensure coordination of care.  If required by patient need, requests that agency provide an in-person skilled nurse visit.
• Supports the physician/patient/agency relationship and plan of care, effectively communicating in a timely manner with other healthcare professionals to coordinate care that addresses identified patient needs.
• Provides comprehensive teaching to patients and caregivers via telephone or audio-visual technology about the principles of virtual care, use of equipment if applicable, disease management protocols, safety and emergency measures, and other health-related issues per the plan of care.
• Empowers and coaches patients to strengthen self-management strategies for their chronic disease(s) and become active participants in their healthcare journey.
• Instructs and supervises the patient’s family/caregiver in care of the patient and maintenance of a safe and healthy environment for the patient.
• Responds quickly and with as much flexibility as possible to an agency’s request to triage urgent patient needs.
• Actively participates in case conferences at assigned agencies.
• As appropriate to experience and training, serves as a subject matter expert and resource regarding diagnosis-specific best practice to agency staff and peers.
• Maintains up-to-date knowledge base and helps to educate fellow employees regarding administrative elements of virtual care, including (as applicable) telemonitoring definition and concepts, selection of the appropriate patient population, assignment of virtual technologies and tools per patient needs/capabilities and plan of care, equipment set-up and maintenance, cleaning and infection control measures, troubleshooting equipment and connectivity issues, and reducing obstacles to engagement.
• Oversees and directs virtual patient care provided by LPN/MA or non-clinical team members as needed and in accordance with scope of practice and state/federal regulations.
• Assists with orientation of new ProCARE+ team members upon request.
• Maintains productivity standards as assigned.
• Monitors personal performance and quality metrics; compiles and submits data points for analysis by leadership upon request; assists with evaluation of virtual care program’s outcomes and effectiveness regarding reducing risk of hospitalization, improving patient outcomes, and enhancing patient satisfaction and quality of life.
• Exhibits exemplary oral communication skills when assessing or educating patients/caregivers, performing telephone triage, or collaborating with fellow healthcare professionals.
• Demonstrates excellent written communication skills when documenting activities in a complete, accurate, and timely manner, including all telephone, audiovisual, and text/email contacts, in accordance with organizational standards and protocols.
• Takes necessary actions to maintain professional licensure at all times; completes required initial and annual education, as well as additional courses that may be assigned, in a timely manner.
• Evidences self-motivation and ability to work independently with minimal supervision.
• Displays consistent comm