Chapters Health System

Social Worker

• Responsible for the direct social work case management services to PACE participants.
• Provides social services support to include participant screening, case management, counseling, and referral.
• Participate in the Interdisciplinary Team’s initial assessments, care planning and ongoing re-evaluations of participant’s case.
• Maintain current written case management records, including periodic reassessments of program participants.
• Refer participants to appropriate community agencies or facilities, act as a liaison with such organizations and as advocate for participants.
• Consult with and advise staff members as to the relationship of social, emotional and cultural factors to health and medical care, and as to the availability of social services in the community.

Social Worker – PACE Program, MSW Required

General

• Provides remote virtual serious illness care management
• Consults with medical staff for optimal patient care
• Performs virtual assessments and manages medication prescriptions
• Participates in departmental and medical staff activities

Nurse Practitioner, Evenings, Nights, Weekends

• Provides fully remote virtual serious illness care management to patients and families throughout our continuum of care.
• Consults with medical staff, and/or other members of the IDT as indicated to ensure optimal patient care in an effective and efficient manner.
• Performs virtual assessment of patient/family/caregiver needs.
• Identifies, manages, orders, and prescribes medication and equipment as appropriate.
• Maintains access to all electronic medical records (EMR), electronic prescribing systems, and other required websites and applications.

Nurse Practitioner

• Provides and coordinates social services including psychosocial support to patients and families
• Performs psychosocial assessments and empowers clients
• Consults with clinical staff to address family dynamics related to health problems
• Maintains documentation reflecting timeliness and accuracy
• Participates in developing individualized Plans of Care and attends Case Conferences

Social Worker – MSW Required

Per Diem

• Under RN supervision, responsible for providing nursing interventions and teaching skills to maximize patient comfort and to enhance the quality of life to the patient/family unit
• Provides nursing tasks to patients and families such as continuous care, dressing changes, catheter changes as identified in the plan of care
• Demonstrates clinical skills regarding application of Company policies and procedures such as: medication administration, symptom management, and patient/family relationships
• Observes/monitors patients for alterations in body systems, pain and symptoms and reports to RN
• Reports findings to physicians, APRNs and physician’s assistants following collaboration with RN
• Performs venipuncture for blood specimens
• Documents per policy and procedure in medical record
• Performs other duties as assigned.

LPN – Per Diem Continuous Care

On Call

• Provides after-hours field visits to patients, families, and community partners.
• Establishes and maintains positive relationships with team members, patients/families, and referral resources.
• Makes after-hours visits to patients in their home, assisted living facility, nursing home, or hospital, anywhere within the assigned affiliate(s) territory.
• Provides compassionate customer service to patients and families.
• Assesses patient/family and identifies immediate needs and appropriate nursing interventions by phone and/or during visit.
• Provides and manages direct care to patients and families as part of Interdisciplinary Group (IDG), incorporating psychosocial, spiritual, cultural, physical and biological components, and appropriate nursing intervention and follow-up.
• Demonstrates clinical skills regarding case management, application of company policy and procedure, physical assessment, intravenous therapies, pain medication titration, symptom management, and patient/family relationships.
• Prioritizes, consults, refers, and collaborates with other professionals to promote quality and continuity of patient/family care.
• Educates patient, family, caregivers and other health professionals about disease process and decline, palliative interventions, care giving, dying process, and safety practices.
• Reports changes in the patient’s condition to appropriate members of the IDG or other health professionals.
• Attends patient deaths; prepares body for transport; oversees disposal of medications; and provides bereavement support.
• Completes documentation per policy and procedure.

On-Call RN, Nights

Collections

• Prepares and submits accurate billing to third party payor’s and self-pay invoices.
• Identifies and resolves billing clearinghouse rejections.
• Conducts root cause analysis on unpaid accounts receivable (AR) and resolves with third party payor’s.
• Analyzes and resolves credit balances.
• Handles incoming and outgoing customer service calls to third party payor’s, outside providers and patients/guarantors to resolve and achieve account resolution.
• Processes correspondence.
• Initiates and resolves technical denial appeals.
• Identifies payor denial and cash fluctuation trends and escalates as appropriate.
• Performs other duties as assigned.