Sign-on bonus $15,000.
Current, unencumbered New York State Registered Nurse (RN) license required.
2+ years of clinical experience in assisted living, long-term care, home care, case management, or geriatric settings (ALP experience a plus).
Strong care coordination skills with knowledge of community resources, payer requirements, and transitions of care.
Familiarity with NYS DOH regulations; experience with UAS-NY assessments and/or managed long-term care (MLTC) preferred.
Proficiency with EMR systems and strong documentation skills.
Excellent communication, critical thinking, and relationship-building skills; ability to work effectively with residents, families, and interdisciplinary teams.
BLS certification required; additional certifications (e.g., CCM, ANCC gerontology) a plus.
Bilingual (e.g., Spanish, Mandarin, Russian, Bengali) a plus given our diverse resident community.
Responsibilities include, but not limited to:
Conduct comprehensive nursing assessments on admission and at regular intervals; update care plans based on resident status, goals, and preferences.
Coordinate and monitor services (home care, rehab, specialty appointments, labs, pharmacy, DME) to ensure timely, appropriate, and cost-effective care.
Facilitate smooth transitions of care (hospital, rehab, home), including pre-admission screening, discharge planning, medication reconciliation, and follow-up.
Collaborate with residents, families/guardians, primary care providers, and the interdisciplinary team to address clinical needs and psychosocial factors.
Monitor clinical outcomes and chronic disease management; identify risks and implement interventions to reduce falls, infections, and avoidable hospitalizations.
Ensure compliance with New York State Department of Health regulations for Assisted Living/ALP settings; maintain accurate, timely documentation in the EMR.
Participate in quality improvement initiatives, audits, and incident reviews; track metrics and implement corrective actions as needed.
Educate residents and families on disease processes, medications, and community resources; provide in-service training for care staff on clinical best practices.
Support medication management processes and coordinate with pharmacy services.
Participate in on-call rotation and respond to urgent resident needs as appropriate.