Job Description

Job Location: 36 Dearborn St - Roxbury, MA 02119
Position Type: Full Time 30+ hoursEducation
Level: 2 Year Degree
Salary Range: $36.00 - $65.02
Job Category: Health CarePosition Title:                     Registered Nurse PACE
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.
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 Manage

QualificationsMinimum 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.