$5,000Sign-on Bonusfor External CandidatesWellMed, part of the Optum family of businesses, is seeking a Home Health RN - Field Based to join our team in Texas. Optum is a clinician-led care organization that is changing the way clinicians work and live.As a member of the Optum Care Delivery team, you’ll be an integral part of our vision to make healthcare better for everyone.At Optum, you’ll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, you’ll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be whileCaring. Connecting. Growing together.Schedule:Weekday:Monday- Friday, 8a-5p or 9a-6pWeekends:Rotating weekends (Sat. and Sun.), one rotating weekend per monthOn-Call Rotation:One week of After Hours on-call rotation from 6p- 8a (Monday - Monday)Primary Responsibilities:Patient CareCompletes an initial assessment of patient and family to determine home care needs. Provides a complete physical assessment and history of current and previous illnessesRegularly re-evaluate patient nursing needsUses health assessment data to determine nursing diagnosisInitiates and develops a Plan of Care, which establishes goals based on nursing diagnosis and incorporates therapeutic, preventative, and rehabilitative nursing care actions. Includes the patient and the family in the planning process. Makes necessary revisions as patient status and needs changePlans and implements patient health teaching and health counseling regarding the disease process(es), selfcare techniques and prevention. Counsels and involves the patient and patients’ family in accomplishing healthcare goals, meeting nursing and related needs while promoting patient/family independenceRe-evaluates patient nursing care needs to include continuous assessment using the OASIS Data Set at appropriate time intervals during the episodeAssesses the patient’s condition during every home health care visit; ensures assessments are communicated to the Clinical Team Manager (CTM) on a daily basis; nursing interventions are implemented to meet patient needs and changing conditionsInitiates appropriate preventive and rehabilitative nursing procedures. Administers medications and treatments as prescribed by the physicianIdentifies patient discharge planning needs as part of the Plan of Care development and implements prior to discharge of the patientAssumes responsibility to coordinate all patient careRecognizes and reports life threatening situations and responds appropriatelyProvides information regarding Home Medical Equipment (HME) and supply needs to the CTM, in a timely manner. Utilizes equipment and supplies effectively and efficientlyPerforms care management duties for patients as assigned including: notifying the physician of changes in the patient’s condition or progress toward goals, obtaining physicians orders as needed, reassessing the patient for recertification, attending and documenting case conferences, initiating coordination of care by reporting significant findings to others on the healthcare team, and planning for notification and documenting the discharge of the patientAdheres to the Agency’s Standard Operating Procedures as it relates to the submission of documentationDocuments all communications with the patient, family, physician, CTM, pharmacy, and other disciplines, as indicated on communication notesPrepares a written plan for the certified Home Health Aide to follow, if applicableEstablished a trusting relationship with patients, caregivers, co-workers, clinic staff members, and physiciansDemonstrates knowledge and observance of Patient Rights and Notice of Privacy PracticesFollows all infection control standard precautions and safety guidelines/standards as per agency policyParticipates in educational programs and all required in-service training programs to maintain comprehensive healthcare knowledge base, as assigned by supervisorComplies with all Homecare Dimensions, Inc. agency’s policies and procedures. Promotes and maintains an agency environment that is in compliance with federal, state, and local regulatory agencies. Participates in the agency’s endeavors for accreditation, licensing, and professional recognition according to state, federal, and/or CHAP requirements. Participates in the Performance Improvement Program activities of the agency and periodic review of clinical records, as assignedCommunication:Prepares clinical notes and updates the primary physician when necessary and at least every sixty (60) daysCommunicates with the physician regarding patient needs and reports any changes in patient condition; obtains/receives physician orders as requiredCommunicates with community health related personnel to coordinate the Plan of CareCoordinates services and schedules with the Clinical Team Manager (CTM) and Clinical Team Coordinator (CTC/Scheduler) to include recommendations for additional home health care services for patients within twenty-four (24) hours of the Start of Care (SOC)Additional Duties:Participates in on-call duties within the on-call rotation schedule, to include weekends as assignedEnsures arrangements for equipment and other necessary items and services are availableInstructs, supervises, and evaluates Home Health Aide care provided every two (2) weeksInstructs, supervises, and evaluates Licensed Vocational Nurses every thirty (30) daysMaintains a daily patient case load and point of care documentation levels as per agency standardsRequires the availability of accepting patients during business hours (8 a.m. - 6 p.m.)Requires updating the electronic timecard daily, as per UHG PolicyRequires contacting patients the night before the scheduled visit to provide an arrival time within a two (2) hour windowRequires obtaining pre-approval from direct supervisor for overtimeRequires the ability to work flexible schedule to meet patient needsDemonstrates personal responsibility with regard to attendance and punctualityMaintains privacy and confidentiality with regard to all patient, staff, and agency informationDemonstrates flexibility, enthusiasm, and willingness to cooperate while working with others or in place of others, as necessaryExpresses verbal and written communication in a clear, positive, and collaborative mannerPromotes the agency’s image by adhering to the agency’s dress codePerforms all other related nursing duties as assignedThis job description is not intended, and should not be construed to be, an exhaustive list of all responsibilities, skills, efforts, or working conditions associated with the job. It is intended, however, to be an accurate reflection of those principal job elements essential for making decisions related to job performance, employee development and compensation. As such, the incumbent may perform other duties and responsibilities as required.In 2011, WellMed partnered with Optum to provide care to patients across Texas and Florida. WellMed is a network of doctors, specialists and other medical professionals that specialize in providing care for more than 1 million older adults with over 16,000 doctors’ offices. At WellMed our focus is simple. We’re innovators in preventative health care, striving to change the face of health care for seniors. WellMed has more than 22,000+ primary care physicians, hospitalists, specialists, and advanced practice clinicians who excel in caring for 900,000+ older adults. Together, we're making health care work better for everyone.You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.Required Qualifications:High school diploma or equivalentGraduate of an accredited school of nursingRegistered Nurse with an active unrestricted license to practice professional nursing in the state of TexasHave and maintain current CPR certificationValid Texas Driver’s License and maintain auto insurance coverage in accordance with organization requirements2+ years of clinical experience preferable in a community home health or medical/surgical settingExperience working with electronic medical record applicationThorough knowledge of current nursing practice, professional standards of care, and state and federal regulations regarding home careDemonstrated ability to define problem, collect data, establish facts, interpret an extensive variety of technical, medical, regulatory instruction and deal with numerous issues to draw a valid conclusionProven evidence of independent nursing practice in delivering nursing careDemonstrated ability to endure prolonged or considerable walking or standing; lift position or transfer patients in a proximate location; lift supplies and equipment; perform reaching, stooping, bending, kneeling, or crouching. Visual acuity and hearing, functional or corrected, to perform required nursing skillsDemonstrated ability to comply with accepted professional standards and practicesDemonstrated ability to prioritize and communicate objectives clearlyDemonstrated ability to interact productively with individuals and with multidisciplinary teamsDemonstrated excellent observation, verbal and written communication skills, problem solving, basic math skills, and nursing skills per competency checklistProven basic computer skills to include: Microsoft Word, Outlook, and other e-mail systemsProven excellent verbal and written skillsPreferred Qualifications:Bachelor’s Degree in nursingBilingual (English/Spanish) language proficiencyWork Environment (Patient’s Home):The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.May work in patient homes under varying conditions with possible exposure to fumes, odors, pets, insects, rodents, blood, body fluids and infectious diseases; some exposures to inclement weather; rotating call and emergency call. In rare occasions, the work environment may involve abusive, combative or psychologically disturbed patient/family members. Requires ability to handle stress situations with calmness and courtesy at all timePay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable.OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.