Deliver remote care throughout an 8 week evidence based program Monitor participant progress, provide follow up communications and care coordination recommendations, and document session notes Participate as a member of the care team and assist participants as needed with accessing resources, as well as obtaining consent and authorization forms Identify and respond to hig

Ensure accurate and complete documentation Communicate and collaborate with the interdisciplinary care team Collaborate and communicate with PCC to support APC care and scheduling of member Assist the provider / team with various care coordination activities Assist the provider / team with benefit determination associated with Medicare part A, part B, and part D benefits

1. 1. Engages individuals during street/community outreach 2. Provides education on healthy behaviors during street outreach, advocacy, referral and support 3. Encourages healthy lifestyles for individuals, families, and communities through health promotions, outreach, and marketing. 4. Inform individuals and families about resources that they would benefit from receiving

1. STANDARDS OF PRACTICE RN practice is guided by the ANA Scope and Standards of Practice (2015). The Standards of Practice describe a competent level of nursing care as demonstrated by utilizing the nursing process components of assessment, diagnosis, outcomes identification, planning, implementation and evaluation. Assessment The registered nurse collects pertinent data

1. Assists the clinician with the care of patients. 1.1 Assists in obtaining, preparation and serving of snacks/lunch on a daily basis under the direction of a supervisor. 2. Coordinates transportation of patients. 2.1 Rides on the van providing assistance to patients to and from programs and/or to outside appointments. 3. Acts as liaison between REACH program and schools

1. Licensed Social Work Clinical Practice 1.1 Interact professionally and with persons of all ages and from diverse cultural, socioeconomic, educational, racial and ethnic backgrounds, genders, sexual orientations, lifestyles, and physical abilities. 2. Professional Development 2.1 Maintain and enhance knowledge base and skill set through educational opportunities and mee

1. STANDARDS OF PRACTICE RN practice is guided by the ANA Scope and Standards of Practice (2015). The Standards of Practice describe a competent level of nursing care as demonstrated by utilizing the nursing process components of assessment, diagnosis, outcomes identification, planning, implementation and evaluation. Assessment The registered nurse collects pertinent data

1. Licensed Social Work Clinical Practice 1.1 Interact professionally and with persons of all ages and from diverse cultural, socioeconomic, educational, racial and ethnic backgrounds, genders, sexual orientations, lifestyles, and physical abilities. 2. Professional Development 2.1 Maintain and enhance knowledge base and skill set through educational opportunities and mee

1. Licensed Social Work Clinical Practice 1.1 Interact professionally and with persons of all ages and from diverse cultural, socioeconomic, educational, racial and ethnic backgrounds, genders, sexual orientations, lifestyles, and physical abilities. 2. Professional Development 2.1 Maintain and enhance knowledge base and skill set through educational opportunities and mee

1. Licensed Social Work Clinical Practice 1.1 Interact professionally and with persons of all ages and from diverse cultural, socioeconomic, educational, racial and ethnic backgrounds, genders, sexual orientations, lifestyles, and physical abilities. 2. Professional Development 2.1 Maintain and enhance knowledge base and skill set through educational opportunities and mee

1. Licensed Social Work Clinical Practice 1.1 Interact professionally and with persons of all ages and from diverse cultural, socioeconomic, educational, racial and ethnic backgrounds, genders, sexual orientations, lifestyles, and physical abilities. 2. Professional Development 2.1 Maintain and enhance knowledge base and skill set through educational opportunities and mee

1. STANDARDS OF PRACTICE RN practice is guided by the ANA Scope and Standards of Practice (2015). The Standards of Practice describe a competent level of nursing care as demonstrated by utilizing the nursing process components of assessment, diagnosis, outcomes identification, planning, implementation and evaluation. Assessment The registered nurse collects pertinent data

1. Assists the nursing staff in maintaining a therapeutic milieu/environment to ensure the care and treatment of patients. 1.1 Acts as a cofacilitator in select unit based therapeutic groups as identified by Nurse Manager. 2. Under the direction of the Registered Nurse, provides individualized patient care to insure the safety and dignity of the patient. 2.1 Collaborates

1. May function independently and may maintain a panel of patients as the assigned PCP 2. Demonstrates excellence in the completion of patient history and physical exams and assessment appropriate to patient population 3. Demonstrates proficiency in treatment plans and interventions, working collaboratively with other APCs, physicians, or specialists when indicated. Presc

1. Assists the nursing staff in maintaining a therapeutic milieu/environment to ensure the care and treatment of patients. 1.1 Acts as a cofacilitator in select unit based therapeutic groups as identified by Nurse Manager. 2. Under the direction of the Registered Nurse, provides individualized patient care to insure the safety and dignity of the patient. 2.1 Collaborates