RN Home Care Case Manager - Home Health

Responsible for

• Perform initial evaluation of patient/home and apply admission criteria to determine if patient is safe candidate for home health/hospice services.
• Provide skilled nursing care to patients and skilled education/instruction to patients and caregivers according to the home health/hospice plan of treatment.
• Perform physical assessments, develop, coordinate, modify and manage written individualized plan of care, as ordered by the primary physician, to meet patient’s long and short-term medical goals and appropriate/timely home health outcomes.
• Develop and clinically manage the Home Health Aide’s care plan according to the patient’s evolving personal are needs.
• Collaborate and communicate with other members of the interdisciplinary team to assure appropriate and smooth flow of care/services through the care continuum.
• Perform discharge planning appropriately towards patient specific goals/outcomes and evaluate interventions and outcomes of patient care by reviewing long and short-term goals established in the plan of care.
• Provide accurate, complete and timely clinical documentation in compliance with regulatory, quality and Agency guidelines.
• Aid in the plan and implementation of family Bereavement services for the following patient death.

Qualifications

• Accredited School of Nursing Required: NursingBachelor's Degree Preferred: Bachelor of Science in Nursing
• Experience 2 years Required: Acute clinical or home health/hospice nursing experience1 year Required: Home health experience preferred or will orient to point of competency
• Required: Registered Nurse in state of practice
• Required: Drivers License and proof of auto insurance
• Basic computer skills including MS Office applications (Required)
• Well organized, flexible and able to function independently (Required)
• Cooperative working skills, leadership skills, and interpersonal skills and ability to work effectively with a wide variety of patients, families and staff (Required)