Position: Adult Family Care RN

General Description:

The Adult Family Care (AFC) Registered Nurse (RN) works directly with the Multidisciplinary AFC Team to provide AFC services and nursing oversight to meet the needs of each member in accordance with the member’s AFC plan of care. The AFC RN participates in required and other relevant training, and reports directly to the Director of Adult Family Care.

General Qualifications:

The Registered Nurse must be fully licensed by the Massachusetts Board of Registration in Nursing and have at least two years of recent experience in the direct care of elders or adults with disabilities. Comprehensive knowledge of nursing care; excellent interpersonal and communication (written/verbal) skills; organization skills; basic computer skills; ability to assess and to develop care plans; and a commitment to working as a team member is needed. Annual physical and bi-annual TB screening is required.

Job Responsibilities and Expectations:

• Complete and coordinate all applicable clinical assessments and clinical evaluations regarding AFC Members’ needs and for Prior Authorization process; includes MDS and PCP order form.
• Develop and review on an ongoing basis each member’s AFC plan of care
• Work in conjunction with the AFC team to select, train, assess and support AFC Caregivers
• Participate in multi-disciplinary team meetings with Director and AFC Care Manager
• Review the PCP Summary Form for new members and complete PCP Order Form in conjunction with the clinical assessment tool (MDS)
• Monitor the health status of all Members and support Caregivers in reporting changes in the Member’s health status to Member’s PCP
• Regularly review Caregiver Logs and other documentation monthly to ensure appropriate level of care for members
• Conduct on-site visits with each member at the qualified setting for purposes of assessment and support for any health related needs following the schedule set by MassHealth regulations
• Complete a nursing progress note for each visit or encounter
• Complete semiannual health-status reports to be sent to Member’s PCP
• In conjunction with the AFC Multidisciplinary Team, plan for and implement discharges and transition from the AFC Program
• Conduct an orientation for each AFC Caregiver before the AFC Caregiver begins personal care
• Provide ongoing training to AFC Caregivers on health and aging
• Provide education for the member about hygiene and health concerns
• Facilitate communication between service providers, families and health professionals as needed to identify specific needs of supported Members
• Assist as needed with urgent and non-urgent needs relating to AFC Members
• Protect the rights and dignities of individuals supported and extend those rights and dignities to family members, caregivers, or guardians. Represent The Arc of Bristol County, Inc. while in the community in a positive and professional manner, consistently communicating the agency’s philosophy and mission.
• Follow all agency and program specific policies and procedures.
• Serve as a back-up support for emergency situations in the AFC program.
• Maintain the accuracy and timeliness of submission of all documentation as related to AFC services.
• Provide occasional back-up coverage for other Arc services that require nursing oversight
• Perform other duties as assigned