Registered Nurse, Outpatient Clinic – Home Health and Hospice | Casual

Holly Thompson

Why Blue Mountain Hospital District & Grant County?

The Blue Mountain Hospital District (BMHD) is located in Grant County, Oregon, at the heart of the John Day River, in beautiful, rural, Eastern Oregon.  Our District is comprised of a Critical Access Hospital (CAH), Family & Rural Medicine Clinic, Home Health and Hospice, Emergency Medical Services, an Intermediate Care Center and all of the supporting ancillary departments necessary to care for the health and wellness of our community.

Our District spans from John Day to Prairie City, nestled in a valley surrounded by the Blue Mountains.  The Strawberry Mountain Range and John Day River Valley offers a variety of outdoor activities, from abundant hiking/mountain biking/horse riding trails, to high and low lakes and ponds.  Our area is known to be a “go to” place not just for recreation, but also for big game hunting and fishing!

Join our family-like team and settle into a lifestyle that is hard to beat!

For more information on our area, visit our Grant County Chamber of Commerce page at: https://www.gcoregonlive.com/

Position Summary:

Registered Nurse: The Registered Nurse will perform duties as assigned in each department:

Outpatient Clinic RN: Wound Care Specialist RN coordinates treatment to provide comprehensive wound assessments and plan of care including goals, implementation of treatment, evaluation and outcomes for patient. Provides patient, family and caregiver education regarding wound management, prevention of wounds, support surfaces, dressing selections and other therapies. Performs diabetic foot care and assessments. Provide education on care of diabetic foot and wound prevention. Performs ear irrigation and assessments, provide education of ear care. Participates in performance improvement and continuous quality improvement (CQI) activities.

Home Health RN: Responsible for planning, coordinating and documenting care for an assigned caseload of patients.  Utilizing physicians’ orders and professional skills the Home Health RN, in conjunction with the Home Health Team, develops and implements a home health plan that meets each patient’s specific needs and is in compliance with accrediting organization standards, federal and state regulations, reimbursement guidelines, as well as agency policies and procedures. Performs supervision of the Home Health Aide.

Participates in performance improvement and continuous quality improvement (CQI) activities

Home Health Case Manager: In addition to the general department RN duties, Home Health Case Manager will perform duties as assigned for the best working development of the Home Health Agency. The Case Manager will be mainly responsible for the overall care coordination of the Home Health case load. Also, will coordinate with physicians, families, and care team for the best outcome for the patient. Participates in performance improvement and continuous quality improvement (CQI) activities.

Hospice RN:  Responsible for the planning, coordinating, providing and documenting care for terminally ill patients from day of admission through day of discharge. Utilizing physicians’ orders and professional skills, the Hospice RN develops and implements a hospice plan that meets each patient’s specific needs and is in compliance with accrediting organization standards, federal and state regulations, reimbursement guidelines as well as the organization’s policies and procedures. Performs supervision of the Home Health Aide

Participates in performance improvement and continuous quality improvement (CQI) activities.

 

Hospice Case Manager:  In addition to the general department RN duties, Hospice Registered Nurse Case Manager provides skilled nursing care for Grant County patients. She assesses the needs of the patient/family unity and plans, implements, and evaluates the nursing care in accordance with physician orders and the interdisciplinary plan of care. Participates in performance improvement and continuous quality improvement (CQI) activities.

Home Health, Hospice, Outpatient Clinic & Coding:  Registered Nurse is responsible for classifying medical data from outpatient records which includes review of documentation and assignment of numeric codes for each diagnosis and procedure using the ICD-10-CM, ICD-10-PCS, and CPT coding systems. RN Coding ensures compliance with established coding systems, third party reimbursement policies, regulations and accreditation guidelines. Responsibilities include collaboration with revenue cycle (billing and collections) to optimize accurate database information, coding proficiencies and reimbursement. RN Coding demonstrates working knowledge of relevant regulatory requirements, official coding conventions and rules established by the American Medical Association (AMA), and the Center for Medicare and Medicaid Services (CMS) for assignment of diagnostic and procedural codes. Knowledge of medical terminology, abbreviations, techniques and surgical procedures; anatomy and physiology; major disease processes; pharmacology; and the metric system to identify specific clinical findings, to support existing diagnoses, or substantiate listing additional diagnoses in the medical record. Participates in performance improvement and continuous quality improvement (CQI) activities.

Essential Functions and Responsibilities:

Registered Nurse (RN) performs delegated duties consistent with his/her scope of practice and functions within the philosophy and overall plan of care delivery for Blue Mountain Home Health Agency, Hospice, Outpatient Clinic and Coding Departments:

Outpatient Clinic:

  • Promotes the mission, vision and values of the BMHD.
  • Obtains necessary supplies to provide care
  • Demonstrate clinical expertise in providing comprehensive assessment of the patient and develop a wound management plan including reduction of causative factors, topical therapy plan, education to patient/family, basic nutritional assessment, goal setting and care coordination to achieve wound closure.
  • Assessment and treatment of acute, chronic, surgical and complex wound using evidence based guidelines.
  • Provides wound related education to patients and BMHD staff on wound prevention and treatments to improve outcomes
  • Supports research by participating in Quality Improvement projects, data gathering, program development and remains informed of current practice standards
  • Demonstrates leadership through maintaining and revising policies and guidelines for the outpatient clinic and contributes to BMHD policy revisions. Also participating on committees as assigned and program development
  • Provide comprehensive care for incontinence issues including selection and care of containment devices or garments, pelvic muscle exercise, catheterization, skin care and hygiene
  • Provide management of peri-stomal/stomal sites, prevention of peri-stomal skin complications and pouch management
  • Maintains professional and technical knowledge by attending educational workshops, reviewing professional publications, attending webinars, establishing professional networks, participates in professional organizations
  • Performs focused assessment of the diabetic foot, nail trimming, debridement of callus and anils and patient education to prevent foot complication. Communicates need for referrals of orthotics, surgical intervention and diabetes management
  • Performs other outpatient procedures to standard of care including: ear examination and irrigation, injections, catheter care, toe nail trimming and debridement of dystrophic nails
  • Demonstrates expertise in wound, ostomy, and continence care by providing consultations for complex cases throughout the BMHD. Provides education to BMHD staff to improve wound, ostomy, continence and foot care outcomes. Assists in program development to improve wound, ostomy, continence and foot care outcomes
  • Maintains policy/protocol for HH Clinic and revises policies and guidelines for outpatient clinic and contributes to district wide policy revisions
  • Eye wash station in the bathroom tested/flushed weekly
  • Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications, attending webinars, establishing professional networks, participates in professional organizations.
  • Any additional duties pertaining to the daily operations of the Outpatient Clinic as assigned by the Home Health/Hospice Director.

Home Health:

  • Has the ability to perform head to toe assessment and reassessment as per policy
  • Develops a written plan of care for each patient
  • Assesses patient’s condition, initiates plan of care, re-evaluates and updates as necessary.
  • Supports and maintains a culture of safety and quality.
  • Obtains all necessary physician orders and collaborates with the physician as the patient’s needs dictate.
  • Participates in case conferences to discuss multidisciplinary team responsibilities, patient progress, plans for continued care, new problems, etc.
  • In coordination with the Case Manager, plans patient discharge from the agency.  Recommends referrals for alternative level of care if necessary.
  • Recommends to Case Manager needed referrals to other disciplines and/or community resources.
  • Obtains needed supplies and equipment to provide care.
  • Plans with the physician to implement changes to improve patient care
  • Reports changes in patient’s physical and emotional health to the physician.
  • Communicates patient’s data and observations verbally and through documentation.
  • Adheres to all agency, billing and documentation policies and procedures.

Hospice:

  • Has the ability to perform head to toe assessment and reassessment as per policy
  • Performs physical and psychosocial assessment on all hospice patients.
  • Ability to adequately assess and reassess pain.  Utilizes appropriate pain management techniques.  Educates the patient and family regarding pain management.
  • Develops a written plan of care for each patient.
  • Responds to the physical, mental, social and emotional needs of terminally ill patients and their families.
  • Assesses patient’s condition, initiates plan of care, re-evaluates and updates as necessary.
  • Initiates needed referrals to other disciplines and/or community resources.
  • Supervises Hospice Aides on an every other week basis.
  • Understands Hospice philosophy and issues of death and dying.
  • Initiates case conferences to discuss multidisciplinary team responsibilities, pain management, bereavement counseling, new problems, etc.
  • Adheres to all organization, payroll, billing and documentation policies and procedures.
  • Participates in the organization’s other mandated activities, i.e., in services, staff meetings.

Hospice Case Manager:

  • Specializes in coordinating end of life healthcare and social services for patients and their families while providing supporting and counsel to clients who are facing terminal disease and conditions.
  • Evaluates a patients physical condition and develop a care plan that addresses any medical needs and social services
  • Initiates appropriate interventions and monitors the outcome
  • Educates the patient/family as appropriate per assessment and care plan, and encourages their participation
  • Maintains the on-call schedule. Participates in the agency’s on-call rotation
  • Completes Home Health Aides assignment as needed and makes supervisory visits every 14 days to instruct, supervise, and evaluates home health aide care provider.
  • Plans education ideas with director for IDT education
  • Minimizes non-productive time and fills slow periods with activities that will enable you to prepare to meet the future needs of the agency
  • Hospice admission and benchmarking. Meeting with families to discuss hospice and the benefits
  • Medicare Part D and preauthorization’s with medications
  • Be in the know at all times related to Hospice Satisfaction Survey
  • Completes HART and Export to CMS for Hospice Item Set (HIS)
  • Reviews and updates standing orders at least yearly

Coding RN:

  • Assigns and sequences ICD-10-CM/ICD-10-PCS/CPT codes to diagnoses and procedures for documented information according to established guidelines.
  • Abstracts all necessary information into the electronic health record.
  • Determines the final diagnoses and procedures stated by the physician or other health care providers are valid and complete.
  • Accurately follows coding guidelines and legal requirements to ensure compliance with federal and state regulatory bodies.
  • Quantitative Analysis – Collaborates with department Quality Assurance and Billing for the record to ensure the presence of all component parts such as: patient and record identification, signatures and dates where required, and other necessary data in the presence of all reports which appear to be indicated by the nature of the treatment rendered.
  • Qualitative analysis – Evaluates the record for documentation consistency and adequacy to ensure the final diagnosis accurately reflects the care and treatment rendered including review for compliance with established third party reimbursement agencies and special screening criteria.
  • Contacts providers, when necessary, to train and update them with correct coding information.

Productivity

Demonstrate ability to maintain a high level of output without sacrificing quality.

  • Able to demonstrate and maintain consistent and efficient performance.
  • Able to work with small products with repetitive motion and dexterity required.
  • Ability to determine appropriate course of action in more complex situations.
  • Ability to manage multiple and simultaneous responsibilities and to prioritize scheduling of work.
  • Ability to complete work assignments accurately and in a timely manner.
  • Completes annual education requirements.

Technical Skills

  • Demonstrate ability to learn and maintain appropriate technical skills to effectively support the electronic record system
  • Displays the ability to demonstrate leadership, managerial, good interpersonal relationships and the application of sound administrative principles.
  • Displays an understanding of the facility’s learning management system and keeping required education up to date.
  • Displays proficient understanding of HEART, jHAVEN, and BMHD EMR as well as SWCC EMR.
  • Ability to communicate to effectively, both oral and written through e-mail, presentations etc.
  • Displays an understanding of electronic healthcare systems.
  • Proficiency with Google Calendar, Gmail, Excel, PowerPoint, keyboarding, and reporting.
  • Is knowledgeable of equipment within the units such as DME, Ear Irrigation, ABI Doppler, Foot Bath, Hydraulic Bed, and BMHD Vehicles per policy
  • Completes orientation skills checklist assigned for departments.

Teamwork

Establish & maintain solid work relationships, through communication, cooperation, and positive interaction with all employees, staff and physicians.

  • Approachability – build rapport by making the effort to be cooperative and adaptive, put others at ease, and support co-workers.
  • Listening – practice active listening; display patience when listening to the views of others, and discuss differing opinions with an open mind.
  • Problem Solving work with others to prevent problems & find a solution when issues arise.
  • Effectively and consistently communicates administrative directives to personnel and encourages interactive departmental meetings and discussions.
  • Staff Meetings – Expected to attend departmental staff meetings and other meetings as required by administration.

Customer Service

Exhibit professional behavior while being caring and compassionate.

  • Customer Focusdedicated to meeting the expectations of the internal customer. Demonstrate sensitivity, empathy, concern and respect for others.  Act with the patient care in mind, gain trust and respect by building and maintaining effective relationships.
  • Maintain confidentialityin accordance with the hospital and HIPAA regulations.
  • Maintain patient confidentiality at all times by adhering to the federal HIPAA regulations.
  • Represents the organization in a positive and professional manner at all times.
  • Establish and maintain cooperative working relationships with others including physicians, nurses, administrators, managers, vendors such as Lens Drug and Norco/Lincare, etc.,

Effective Use of Resources

Maximize the resources while minimizing waste and controlling expenses.  This includes the effective use of work time and supplies, working safely, following established work practices, and seeking ways to improve operations.

  • Improvement – recommend procedures that reduce costs and streamline operations while improving quality.
  • Maintain neat, clean and professional work area.
  • Maintain near, clean and professional work vehicles

Initiative

Self-motivate and contribute to ne ideas.

  • Improvements – initiate improvements and apply new methods of working to help achieve goals.
  • Learning on the go develop an action plan when facing new problems, and be open to change, while being part of an interdisciplinary team

Supervisory Responsibilities:

None

Supervised By: 

Reports to the Director of Home Health and Hospice

Knowledge, Skills and Abilities:

  • Maintains knowledge of current wound care standards, care of the diabetic foot, continence and ostomy care
  • Maintains self-motivation and sustains a high level of momentum.
  • Able to successfully prioritize when faced with requests, demands and deadlines.
  • Knowledge of customer service concepts.
  • Must be extremely detail oriented and able to perform charting per federal guidelines
  • Proven ability to communicate effectively, both in written and oral form.
  • Ability to communicate effectively in English, both verbally and in writing.
  • Proven ability to work as part of a team, in a fast-paced production-oriented environment.
  • Expresses excellent judgment, discretion and decision making abilities.
  • Maintains a sensitive, fair and impartial approach to dealing with employees.
  • Supports and maintains a culture of safety, quality and positive patient experience.
  • Working knowledge of relevant regulatory requirements, CMS, National Patient Safety Goals (NPSGs), and continued readiness related to home health, hospice, and outpatient services in this department.
  • Ability to prioritize, highly organized.

Education Requirements:

Required:

  • Graduate of an accredited school of Nursing

Preferred:

  • BSN
  • Working experience in home health/hospice/long term care, critical access hospital setting
  • Working knowledge of electronic records and electronic healthcare systems

Certification/Licensure Requirements:

Required:

  • Basic Life Support (BLS) certified by American Heart Association (AHA). MUST obtain prior to working on nursing units or within assigned department.
  • Must maintain current BLS certification and recertify prior to expiration date.
  • RN License, in good standing with State of Oregon
  • Valid Oregon Driver’s License

Preferred:

  • Knowledge of OASIS or care planning and comprehensive nursing assessments
  • Certified in Wound care
  • Certified in OASIS
  • Certified in Coding
  • Certified in Hospice and Palliative Care
  • Certified in Case Management