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 patience and 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.