Home Health RN On-Call Nurse

Bienvivir All-Inclusive Senior Health (“Bienvivir”) is a community-based, patient-centered, comprehensive health care delivery system that advocates and promotes quality of life, optimum independence, dignity, and choices in a nurturing environment for frail seniors. Since 1987, Bienvivir has served the frail seniors of El Paso, Texas through the provision of the Program of All-Inclusive Care for the Elderly (“PACE”).

PACE is a unique managed care benefit for frail seniors (referred to as participants) age 55 and older who are certified by the state as needing nursing home level care and who reside in a PACE service area. PACE programs coordinate and provide comprehensive medical and support services so that participants can remain independent and stay in their homes for as long as safely possible.

• We pay 100% of the MEDICAL monthly premiums for Employee Only coverage.
• We pay 100% of the DENTAL monthly premiums for Employee Only coverage.
• We provide an affordable VISION monthly premium for Employee + Family coverage.
• We pay 100% of BASIC LIFE for a benefit amount of $10,000.
• We offer safe harbor matching contributions for the 403(B) RETIREMENT SAVINGS account.
• We offer up to fifteen (15) days of PAID TIME OFF based on paid hours per pay period.
• We offer eleven (11) company-observed PAID HOLIDAYS.
• We offer education and TUITION REIMBURSEMENT.
• We offer MILEAGE REIMBURSEMENT.

Under the supervision of the Home Health Nursing Supervisor, the Home Health (HH) Registered Nurse (RN) on-call is responsible for providing on-call nursing coverage during assigned shifts to ensure continuity of care for all Bienvivir participants. The RN will answer calls via telephone and provide clinical triage by responding to participants, family, on-call MD/NP and caregiver calls, and determine the need for Skilled Nursing (SN) visits.

The RN conducts scheduled and as‑needed SN visits to complete triage assessments, manage symptoms, and address changes in participant condition. The RN provides direct nursing care with an emphasis on effective communication, symptom and disease management, participant and caregiver education, prevention and maintenance interventions, accurate documentation and regulatory compliance, in accordance with Texas Health and Human Services Commission (HHSC) requirements.

• Be available via telephone to receive and prioritize calls from BSHS telephone answer system and to follow up with participants’ medical needs and concerns.
• Monitor and retrieve voicemail messages during assigned on‑call hours. Return calls in a timely and professional manner. Coordinate with nurse triage line, providers, or emergency services as needed. Triage participant concerns based on clinical urgency; providing clinical guidance based on scope of practice.
• Manage after‑hours communication related to participant emergency room visits, hospital admissions, and discharges. Notify providers and the interdisciplinary team, coordinate and review discharge orders, communicate care needs to facilities or caregivers.
• Work in coordination with other after‑hours on‑call staff via phone to address participant medical needs and arrange urgent medications, DME, or services.
• Communicate effectively with participants, caregivers, and designated representatives to coordinate care and respond to clinical concerns and phone calls promptly.
• Maintain communication regarding participant’s care with the Provider, HH Nursing Supervisor, and family, as appropriate.
• Provide a comprehensive end‑of‑shift email report to support continuity of care, detailing all interventions and resolutions rendered.

• Perform Skilled Nursing visits in participants’ private residences, assisted living facilities, and other approved locations for Bienvivir participants.
• Provide nursing interventions according to the participants plan of care.
• Administer medications and treatments per provider orders.
• Facilitate transitions of care and support continuity across settings, including hospital, skilled nursing facility, and…