Mobile Integrated Health Remote Patient Monitoring Nurse, Per Diem (PD)

Job Description Summary

The MIH/RPM nurse will be under the general guidance of the Clinical Innovation Physician and Directors of EMS/MIH and will administratively report to Dr. Lannutti. The nurse will work in close collaboration with the population health, innovation, SSVNA and care management departments. This System role will screen referrals to MIH from South Shore Health colleagues for appropriateness, as well as serve as a patient-facing resource for MIH patient triage and remote patient monitoring. Key responsibilities include supporting the identification and screening of referrals to the MIH program and providing triage nursing and support to Mobile Integrated Health staff and patients. This role will be responsible for patient outreach in person and telephonically assisting to promote care in the right place at the right time.

Job Description

Essential Functions:

1.  Liaison

    a.  Act as a liaison between inpatient / ED and Care Connect Center Care Coordination staff and Mobile Integrated Health (MIH) and SNF at Home programs

    b.  Conduct screening of patients and facilitate appropriate linkage to MIH /SNF at Home service coordination.

    c.  Assist MIH Coordinator with placement of patients in appropriate MIH program

    d.  Provide nursing support to MIH clinicians and directly to patients when needed

    e.  Be available for communication amongst care partners with ease via phone, email, tiger connect, epic messaging during working hours at all times.

2.  Nursing Triage

    a.  Respond to MIH patient/caregiver calls to MIH.

    b.  Triage patient calls to MIH and provide appropriate guidance.

    c.  Identify patients in need of MIH visit and coordinate with MIH Coordinator.

    d.  Monitor patient vital signs via Remote Patient Monitoring devices and appropriately elevate concerns.

    e.  Participate in weekly MIH team SNF at Home meetings.

    f.  Patient outreach in person and telephonically. Conducting home visits as needed.

3.  Education

    a.  Support reinforcement of education regarding programs with care management colleagues, health system providers and PCPs

    b.  Work closely with leadership and training on program changes, updates.

4.  Safety Awareness – Foster a “Culture of Safety” through personal ownership and commitment to a safe environment.       

    a.  Verifies the patient using two unique identifiers.             

    b.  Complies with the current CDC hand hygiene guidelines through proper handwashing, as observed by the nurse manager and peers.

    c.  Makes appropriate use of personal protective equipment at all times.

    d.  Adheres to universal precautions.

5.  Professional Development         

    a.  Assumes overall responsibility for professional development by incorporating evidenced-based practice, research, and performance improvement initiatives as a part of ongoing practice.            

    b.  Maintains current knowledge/certification licensure and is able to produce evidence of continued education in the field.               

    c.  Pursues professional development.

6.  Technology and Learning

    a.  Participates in continued learning and possess a willingness and ability to learn and utilize new technology and procedures that continue to develop in their role and throughout the organization.

    b.  Embraces technological advances that allow us to communicate information effectively and efficiently based on role.

    c.  Able to navigate multiple technology platforms to support work; to include Epic Care Link, My Chart, Patient Ping, Arcadia, Tiger Connect, Zoom, Jabber and Outlook.

    d.  Must have a smartphone mobile device available for business use which can support Tiger Connect communications at all times during work day

Patient Contact:     Yes

Ages:   Adults 19-70, Geriatrics 70

Competencies:  Chronic Disease Management, Adult age 18 and over, geriatrics

Job Requirements:

LPN or RN

Required License:

LPN or RN

Minimum Work Exp:

Must be experienced with coordinating services, applying criteria to determine clinical eligibility for programs.

Experience in nursing triage.

Experience in home care, VNA, working with patients in chronic/complex disease management and/or SNF/LTC preferred 

Required additional knowledge:

Prefer highly motivated, tech-savvy, energetic and experienced nurse (LPN or RN). This individual should have skills in the following areas:  customer service, communication, technical platforms and mobile applications, strong interpersonal skills and clinical triage.