Registered Nurse (RN) Case Manager | Avera at Home

Location: Avera at Home Yankton. Regular position, day shift.

About the role

Responsible for care planning, utilization of services, coordination of care, and education of the interdisciplinary teams in managing patient care services. Develops patient care plans in collaboration with the physician and interdisciplinary team, providing patient-centered care efficiently and effectively for the best possible outcomes.

Responsibilities

• Function as interventionalists in the home using clinical expertise and problem-solving to make recommendations to physicians based on comprehensive patient assessments (physical, psychosocial, emotional, spiritual, and bereavement).
• Implement the nursing process with highly proficient assessment skills during Start of Care visits, post-hospital evaluations, patient re-certifications, discharges, and supervisory visits.
• Partner with physicians and the interdisciplinary team to develop the plan of care in collaboration with the patient.
• Make recommendations for efficient and effective utilization of resources to achieve positive outcomes by implementing clinical protocols during admission visits as dictated by the patient’s diagnosis.
• Initiate and respond to requests for changes in plans of care, determining appropriateness and whether changes constitute a Significant Change in Condition requiring an OASIS assessment.
• Demonstrate ability to influence behavior to align with recommended care alternatives, including thorough instruction and disease management education for patients and/or caregivers as ordered by the physician.
• Educate patients, families, and caregivers about disease processes, community resources, and recommended self-care.

Requirements

• Must be able to work the specified hours.
• Visual acuity adequate to perform position duties and ability to communicate effectively, hear, understand, and distinguish speech and other sounds.
• Ability to perform essential job functions satisfactorily; reasonable accommodations may be made for individuals with disabilities if they do not cause undue hardship to the employer.

Qualifications

• Required: Registered Nurse (RN) – Board of Nursing (upon hire).
• Preferred: 1-3 years of experience in home health or hospice.

Expectations and Standards

• Commitment to Avera’s mission, vision, core values, and social principles in daily service to patients, families, and the community.
• Promote Avera’s values of compassion, hospitality, and stewardship.
• Uphold Avera’s CARE standards (Communication, Attitude, Responsiveness, Engagement).
• Maintain confidentiality and work effectively in a team environment.
• Comply with safety principles, laws, regulations, and standards (e.g., CMS, The Joint Commission, DHHS, OSHA).

Pay

$32.50 - $48.50 per hour, dependent upon experience.

Schedule

• 8:00 AM – 5:00 PM with weekend, holiday, and on-call involvement.
• 72 hours per 2-week pay period.

Benefits

• Paid Time Off (PTO) available from day one for eligible hires.
• Up to 5% employer matching contribution for retirement.
• Career development through hands-on training and mentorship.
• May be eligible for a $20,000 sign-on bonus.