Home Health RN Case Manager

• Provides skilled nursing care in a patient’s home as ordered by the attending physician

• Observes and monitors patient conditions

• Performs OASIS assessments to develop an individualized plan of care and makes adjustments as needs change

• Administers medication as prescribed by the physician

• Helps decrease re-hospitalizations by front loading visits for high risk patients

• Manages multi-disciplinary care as applicable

• Promotes continuity of care with appropriate admissions, transfers and discharges

• Counsels patient and family on the disease/injury processes and how to manage

• Incorporates patient and family in development of plan of care

• Helps decrease re-hospitalizations by teaching the patient on preventative measures and making good decisions

• Listens to patient and family members

• Oversees and supervises total care of patient provided by Aides and LPNs

• Evaluates the treatments and medical condition of the patient according to the plan of care

• Determines if the level of care being provided meets the patients’ needs

• Communicates with the LPNs and Aides on supervisory visit results

• Completes all clinical documentation in accordance with agency protocol and Medicare/Federal guidelines

• Documents all aspects of treatment, assessments, and patient education

• Maintains active RN license in state of employment

• Communicates with scheduler any changes outside the normal

• Participates in all on-call requirements and case conferences

• Attends in-service trainings and mandatory agency meetings

• Maintains a professional appearance as a representative of the company

• Understands and practices agency policies and procedures

• Drives to patient’s primary location per scheduled visit.

• Daily attendance at assigned visit locations.

• Documents all aspects of subsequent, discharge, eval/recert/resumption of care visits within 24 hours of visits.

• Documents all aspects of start of care visits within 24 hours of visits.

• Completes and submits all required documentation within specified company requirements.

• Follows plan of care as permitted within the scope of practice for a Registered Nurse.

• Fulfills RN visits in assigned geographic location per patient need within federal and state specifications.

• Other duties as assigned.

• Minimum of one year of experience as an RN in an acute care setting. Home care experience is desired.

• Ability to effectively communicate and create positive impressions with patients, families, physicians and co-workers.

• Ability to remain calm, have patienceand be accommodating. Compassionate and caring while working with patients.

• Knowledgeable on nursing best practices.

• Ability to make appropriate nursing judgments.

• Ability to identify a situation and handle it with the best possible solution.

• Detail-oriented and observant.

• Disciplined style of work ethic with the ability to prioritize and be timely

• Ability to follow directions and work as a team member.

• Valid driver’s license and auto insurance with your name as a listed driver.

TRANSITIONAL WORK IS AVAILABLE (ALTHOUGH SOME JOBS MAY REQUIRE SPECIFIC TRAINING) SUCH AS: ANSWERING PHONES, FILING, COMPUTER WORK/DATA ENTRY, ATTENDING TRAINING/CONTINUING EDUCATION, REVIEWING SAFETY MANUALS & OTHER EDUCATIONAL MEDIA, AND ASSISTING OR PERFORMING OTHER TASKS WITHIN RESTRICTIONS ASSIGNED.