Registered Nurse (RN) - PACE

## Description

**Position Title:** Registered Nurse - PACE Program

**Department:** PACE

**Supervisor:** Nurse Manager

**Status / Hours per week:** Non-Exempt / 40 hours

*Pay Range: The expected base pay for the position is $36-$65.02 per hour and may be increased based on other factors, such as language, certifications, etc.*

***Note:**The PACE RN position is based within UCC's PACE Centers, with visits to participants' homes as needed. The regular schedule is Monday - Friday (8am - 4pm).*

**Primary Function:**

Provide comprehensive nursing care to PACE participants in the center setting, including assessments, medication administration, treatments, and coordination of care. Collaborate with the interdisciplinary team to ensure safe, high-quality services that promote participant independence and well-being. Provide home visits as needed.

**Duties & Responsibilities:**

• Complete initial and semi-annual nursing assessments for participants.
• Implement physician orders and document all interventions in the electronic medical record (EMR).
• Conduct nursing assessments for pre-enrollees and complete the nursing section of the MDS; review and sign completed MDS forms.
• Develop and implement individualized nursing care plans for assigned participants.
• Manage medication plans, including ordering from the pharmacy, coordinating timely deliveries, ensuring administration, and providing education to participants and caregivers to promote adherence.
• Collaborate with Contracted nursing agencies, Assisted Living Facilities, rest homes, and nursing facilities to ensure continuity of care.
• Perform monthly medication audits to ensure medications administered and dispensed at the center are not expired or compromised; document findings using audit tools.
• Provide nursing assessments and interventions according to daily schedules and episodic needs at the PACE center.
• Administer immunization screenings and vaccinations per policy and procedure.
• Document all nursing interventions accurately using designated EMR tools.
• Establish and maintain collaborative relationships with participants and caregivers to enhance quality care.
• Report, document, and track infections, wounds, and falls; assist with data analysis and improvement initiatives; monitor vaccination administration.
• Support training, supervision, and competency evaluation of Medical Assistants and Health Aides in collaboration with the Nurse Manager and Center Manager.
• Provide clinical supervision, guidance, and resources for Medical Assistants and Health Aides at the PACE Center.
• Oversee and review data input by Medical Assistants and Health Aides to ensure accuracy and authorize documentation for the medical record.
• Participate in all clinical meetings (morning huddles, team meetings, intake, staff meetings) and designated family meetings.
• Participate in the on-call rotation as scheduled.
• Perform home visits as needed.
• Perform other responsibilities as assigned by the Nurse Manager.

## Qualifications
**Minimum Basic Knowledge:**

• Proficiency in Microsoft Office applications, including Excel and Word.
• Strong written and verbal communication skills.
• Ability to collaborate effectively within an interdisciplinary team environment.
• Valid driver’s license and reliable transportation for home visits.
• Knowledge of infection control practices and home safety standards.
• Familiarity with electronic medical records (EMR) and accurate documentation standards.
• Understanding of medication management principles and patient education techniques.
• Ability to prioritize tasks and work independently in a home-based setting.

**Experience & Qualifications:**

• Registered Nurse licensed to practice in Massachusetts.
• Have 1 year of experience working with a frail or elderly population
• Valid driver’s license and reliable vehicle for home visits.
• Ability to work effectively with multicultural staff, participants, and caregivers.
• Ability to function as a collaborative member of an interdisciplinary team.
• Bilingual skills in Spanish, Portuguese, or Haitian Creole preferred.
• Discharge planning experience desirable.
• Proficiency in electronic medical records (EMR) systems and accurate documentation practices.
• Strong organizational and time-management skills for independent work in home settings.

**Essential Functions:**

• Perform initial and semi-annual nursing assessments and develop individualized care plans.
• Implement physician orders and maintain accurate documentation in EMR.
• Manage medications, including ordering, delivery coordination, and participant/caregiver education.
• Provide scheduled and episodic skilled nursing visits in the PACE and home setting.
• Collaborate with the interdisciplinary team on care planning and discharge coordination.
• Participate in team meetings, on-call rotation, and quality improvement activities.
• Ensure compliance with infection control and home safety standards.
• Complete other duties as assigned by the Nurse Manager.

**Physical Requirements:**

• Ability to travel to participant homes and community locations; must maintain a valid driver’s license and reliable transportation.
• Frequent standing, walking, bending, and reaching during home visits and nursing procedures.
• Ability to lift, push, or pull up to 25 pounds (e.g., medical supplies, equipment).
• Manual dexterity for performing nursing tasks and operating medical equipment.
• Visual and auditory acuity sufficient for assessing participants, reading medical records, and communicating effectively.
• Ability to tolerate exposure to various home environments, including potential allergens, pets, and varying temperatures.
• Capacity to respond quickly in emergency situations and perform CPR if required.

**Independent Action:**

• Ability to work independently and manage priorities

**Supervisory Responsibility:**

• Provide clinical oversight and guidance to Medical assistants, health aides, and nursing students during home visits as assigned.
• Collaborate with the Nurse Manager on performance improvement initiatives and quality assurance activities.
• Serve as a resource for Health Aides and caregivers regarding clinical questions and best practices.

**Define Access Level to PHI:**

Level 4: Authorized to access full health information. UCC position and job responsibilities involve the provision of patient care and working as a clinical team member. Staff in this category level, although allowed full access, should only access the necessary information for each respective treatment encounter/circumstance.