As a Home Health RN Case Manager, you will:
- Provide admission, case management, and follow-up skilled nursing visits for home health patients.
- Administer on-going care and case management for each patient, provide necessary follow-up as directed by the Clinical Manager.
- Confer with physician in developing the initial plan of treatment based on physician's orders and initial patient assessment. Provide hands-on care, management and evaluation of the care plan and teaching of the patient in accordance with physician orders, under Clinical Manager's supervision. Revise plan in consultation with physician based on ongoing assessments and as required by policy/regulation.
- Coordinate appropriate care, encompassing various healthcare personnel (such as Physical Therapists, Occupational Therapists, Home Health Aides and external providers).
- Report patient care/condition/progress to patient's physician and Clinical Manager on a continuous basis.
- Implement patient care plan in conjunction with patient and family to assist them in achieving optimal resolution of needs/problems.
- Coordinate/oversee/supervise the work of Home Health Aides, Certified Home Health Aides and Personal Care Workers and provides written personal care instructions/care plan that reflect current plan of care. Monitor the appropriate completion of documentation by home health aides/personal care workers as part of the supervisory/leadership responsibility.
- Discharge patients after consultation with the physician and Clinical Manager, preparing and completing needed clinical documentation.
- Prepare appropriate medical documentation on all patients, including any case conferences, patient contacts, medication order changes, re-certifications, progress updates, and care plan changes. Prepare visit/shift reports, updates/summarizes patient records, and confers with other health care disciplines in providing optimum patient care.
- Diploma, Associate or Bachelor Degree in Nursing
- Minimum of one year nursing experience preferred
- Strong med surg, ICU, ER, acute experience
- Home Health experience a plus
- Current and unrestricted Registered Nurse licensure
- Current CPR certification
- Strong organizational and communication skills