RN Case Manager- Home Health

How You'll Help

Transform Healthcare

• Manages nursing care and provision of individualized care for patients of all ages.
• Utilizes delegation and critical thinking skills to provide quality service through a team-oriented, collaborative approach to patient care.
• Affirms primary accountability for managing nursing care and providing individualized care for patients of all ages.
• Affirms responsibility for assessing, planning, implementing, and evaluating patient care to achieve optimum outcomes.
• Affirms responsibility for completing and documenting age-specific admission and ongoing assessments to support the plan of care.
• Collaborates with the health care team, patient, and family to develop, implement, and revise the interdisciplinary plan of care.
• Affirms responsibility for administering and documenting treatments and medications using electronic medical record systems.
• Affirms responsibility for ensuring patient care orders are current, accurate, implemented, and evaluated for effectiveness.
• Affirms responsibility for identifying, implementing, and documenting patient and caregiver education needs.
• Affirms responsibility for promoting patient safety, patient-centered care, and positive outcomes during transitions of care.
• Affirms responsibility for serving as a patient advocate and supporting patients' psychological, social, and cultural needs.
• Affirms responsibility for applying knowledge of growth and development to care for assigned patients.
• Affirms responsibility for utilizing clinical expertise in rapidly changing circumstances.
• Affirms responsibility for planning strategies to prevent avoidable rehospitalizations, reduce resource use, and improve patient outcomes.
• Affirms responsibility for managing resources, establishing priorities, and seeking supervisory direction as needed.
• Affirms responsibility for using problem-solving skills to resolve patient care and staff issues.
• Affirms responsibility for participating in performance improvement activities and assigned projects.
• Affirms responsibility for assisting with providing orientation to new employees and serving as a clinical role model.
• Affirms responsibility for managing all aspects of assigned patient care, including case conferences and care coordination.
• Affirms responsibility for supervising LPNs and Home Health Aides as required by regulatory guidelines.
• Affirms responsibility for maintaining accurate and current case management documentation.
• Affirms responsibility for ensuring visit frequencies reflect provider orders and evidence-based practice.
• Affirms responsibility for collaborating with scheduling, billing, and other departments to support care coordination, authorization, and communication of patient financial obligations.
• Affirms responsibility for performing skilled visits, including OASIS and recertification visits, as needed.
• Affirms responsibility for coordinating required forms, including BIPA, ABN, HHABN, or other forms required by CMS or agency policy.
• Affirms responsibility for securely using electronic devices to access, transfer, and synchronize information to support communication and continuity of care.
• Affirms responsibility for coordinating hospice patient and family care in collaboration with the hospice interdisciplinary team, Medical Director, and attending physician.
• Affirms responsibility for providing competent, compassionate care in a variety of settings.
• Affirms responsibility for complying with hospice policies and procedures.
• Affirms responsibility for participating in special hospice events, such as grief camps and memorial services.

What We Require

• Education: Graduate of accredited Registered Nurse Program.
• Experience: None.
• Licensure/Certifications/Registration: Currently licensed as Registered Nurse in the state of Virginia or approved compact state.
• Other Minimum Qualifications: Keyboarding skills required for automated computer systems, including electronic medical records. Demonstrates knowledge of the principles of life span growth and development and assesses data reflective of the patient's status. Interprets the appropriate information needed to identify each patient's requirements relative to their age-specific needs and provides care according to departmental policies and procedures. Work involves application of advanced knowledge and skills of patient care. Strong critical thinking skills are necessary and needed to interpret laws and regulations related to CHCS and Carilion Clinic. Work is performed in a patient care environment and is often fast-paced, requiring use of prioritization skills. Applies knowledge of growth and development to appropriately care for patients served.