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-Initial and ongoing comprehensive assessments of the clients needs, including Outcome and Assessment Information Set (OASIS) assessments at appropriate time points.\ -Initiating the plan of care and revising as necessary.\ -Providing those services and/or treatments requiring substantial and specialized nursing skill.\ -Counseling the client and family in meeting nursing and related needs.\ -Initiating appropriate preventative and rehabilitative nursing procedures.\ -Preparing clinical and progress notes.\ -Coordination of services.\ -Referral to other services as needed.\ -Informing the physician and other staff of changes in the clients needs.\ -Evaluating the outcomes of care.\ -Re-evaluate the patient plan of treatment at least every 60 days and when there is a change in the patient condition, after a hospital stay, and at time of discharge revising the Plan of\ Treatment as needed to achieve patient goals.\ -Supervising LPN/LVNs and paraprofessionals providing services.\ -Assigning home health aide to a specific patient.\ -Participating in in-service programs.\ -Planning for the discharge from service.\ -Provides patients and staff supervision 24 hours a day when assigned on-call.\ -Collaborating with leadership/management team and office staff to facilitate timely office processing of paperwork and personnel information.\ -Actively participates in Agency quality improvement activities.\ -Promote the Agency and services to the public and participate in physician and community education related to services provided by the agency as registered.\ -Performs other duties as assigned.\ -Maintains responsibility to develop professional self attend seminars, and identify self-learning needs, collaborates with agency leaders in meeting learning needs.

Licensed Practical and Licensed Vocational Nurses

Must be able to travel to prospective patients place of residence