John Njuguna

• Provides community-based nursing care to medical, psychiatrist, disabled, and elderly population
• Involved in medication management, assessment of wellbeing and coordination of community resources to help these patients cope with their illness in home setting
• Administers skilled nursing care to clients requiring professional nursing services
• Follows physician’s orders to promote and restore client’s health
• Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
• Administered medications via oral, IV, and intramuscular injections and monitored responses.

• Provides community-based nursing care to medical, psychiatrist, disabled, and elderly population
• Involved in medication management, assessment of wellbeing and coordination of community resources to help these patients cope with their illness in home setting
• Administers skilled nursing care to clients requiring professional nursing services
• Orients new nurses and precepts students
• Follows physician’s orders to promote and restore client’s health
• Communicates regularly with physicians, social workers, physical/occupational therapists, insurance representatives, day programs, and protective services
• Completes Oasis, 485s, creates/implements/evaluates nursing care plans for each client.
• Advocated for patients by communicating care preferences to practitioners, verifying interventions met treatment goals and identifying insurance coverage limitations.
• Effectively communicated with physicians regarding patient needs, performance, medications and changes.

• Completes and coordinates all applicable clinical assessments and clinical evaluations
• Trains, evaluates, and supports Caregivers in conjunction with care manager as needed on on-going basis
• Provide ongoing coaching to drive effective utilization of established best practices
• Works collaboratively to develop and review on ongoing basis, each member’s plan of care
• Reviews caregiver notes daily and appropriately addresses changes in consumer’s condition or environment
• Completes nursing progress note corresponding with each on-site visit or encounter, or more often as member’s condition warrants
• Submits semi-annual health-status reports to each member’s PCP based on regulatory requirements
• Monitors health status of all members to ensure that all needed AFC is properly delivered
• Reports changes in health status of any member to member’s Primary Care Physician
• Plans and implements discharges and transition from AFC program
• Ensures continuous survey readiness and compliance with accepted professional standards and practices and federal/state/local regulations including fraud, waste, and abuse prevention; HIPAA and similar regulations; occupational safety and health standards; and company policies, procedures, and performance standards.

• Facilitates and delivers preventative and basic interventive care to members, as needed
• Provides regularly scheduled follow up visits and telephonic calls for the management of chronic disease or end of life
• Performs comprehensive member assessments taking a detailed history and performing a physical examination
• Conducts minimum data set (MDS) assessments for panel members
• Manages panel-wide and member-specific utilization trends
• Liaises with CCA and community-based PCPs/specialists
• Provides intermittent skilled care, as necessary (e.g., wound care)
• Ensures appropriate documentation of member visits.
• Coordinated referrals to specialists, hospitalizations, ER visits, ancillary testing, and other enabling services for patients.

• Managed and mentored up to 8 clinical managers, 70 case managers and other support administrative staff.
• Effectively oversaw overall operation services of assigned region that entails patient services, financial management, quality assurance, risk management, patient care, employee satisfaction and retention.
• Assisted Executive Director/Administrator in preparation and administration of organization's budget. Monitored budget on monthly basis and was responsible to operate within approved budget while providing excellent quality of care.
• Ensured continuous high quality and safe delivery of home health services provided through organizations.
• Maintained open lines of communication with staff to boost morale, improve processes, enhance problem solving and maintain proactive work environment.
• Assisted clinical managers in managing clinical teams and planning for timely completion of all requirements within assigned area.
• Implemented and directed different care models to improve patients’ outcomes and staff’s life work balance.
• Provided help in assessment, planning, implementation and evaluation of patient/client and family/caregiver care to all clinical personnel as indicated.
• Assisted clinical managers to develop skills and techniques in evaluating performance of clinicians.
• Participated in recruitment, hiring and off-boarding process.
• Coordinated and completed process of annual evaluations on assigned clinical staff. Managed individual performance and
• Implemented performance improvement programs for underperforming staff when required.
• Assisted in planning and implementation of new clinical services and continuing education services and continuing education programs to meet education and training needs of agency personnel.
• Assisted with evaluation and improvement of organization performance via performance improvement program based on current or projected area results. Produced and provided weekly, monthly, quarterly and annual reviews. Performed gap analysis where necessary and implemented corrective actions as needed when expected results are not achieved.
• Assured compliance with local, state and federal laws regarding licensure and certification of agency personnel and maintained compliance with accreditation home care standards where applicable.
• Interpreted operational indicators to detect census changes and increases or decreases in volume that could impact staffing levels, revenues or expenses.
• Promoted home health referrals in health care community.
• Oversaw maintenance of patient clinical records, statistics, reports and records for purposes of evaluation and reporting of organization activities.
• Worked as on-call supervisor back up on call and did MAP consults for group homes across state.

• Oversight of clinical integrity of Oasis documentation, visit utilization, plan of care and care coordination between clinical and field staff
• Provide oversight and delegation of the assessment of clients including updating of care plans and interpreting client’s needs, while adhering to the Innovive policies and procedures
• Provide oversight of communication between team members to ensure appropriateness of care and outcome planning and ensure compliance through review of clinician’s documentation.
• Identified opportunities to improve clinical practices, devised strategies and implemented plans to increase patient care standards and enhance operational procedures.
• Communicated effectively with staff members, physicians, and patients, employing active listening and interpersonal skills.

• Provides community-based nursing care to medical, psychiatrist, disabled, and elderly population
• Involved in medication management, assessment of wellbeing and coordination of community resources to help these patients cope with their illness in the home setting
• Administers skilled nursing care to clients requiring professional nursing services
• Orients new nurses and precepts students
• Follows physician’s orders to promote and restore client’s health
• Communicates regularly with physicians, social workers, physical/occupational therapists, insurance representatives, day programs, and protective services
• Completes Oasis, 485s, creates/implements/evaluates nursing care plans for each client.

• Responsible for coordination of skilled patient care as part of multi-disciplinary health care team on rehab unit
• Tasks include overseeing CNA, LPN, and RN staff to ensure delivery of quality patient care
• Collaborating with physicians, nurse practitioners, therapists, dietitians, social workers, and mental health practitioners
• Developing and executing care plans in collaboration with family members and multi-disciplinary health team
• Administration of medications, performing skilled nursing procedures, family meetings, and patient education.
• Administered medications via oral, IV, and intramuscular injections and monitored responses.