RN, Case Manager

divh2RN, Case Manager/h2pIts inspiring to work with a company where people truly BELIEVE in what theyre doing!/ppWhen you become part of the Chapters Health Team, youll realize its more than a job. Its a mission. Were committed to providing outstanding patient care and a high level of customer service in our communities every day. Our employees make all the difference in our success!/ph3Job Profile Summary/h3pRole: The RN, Case Manager is responsible for assessing and identifying patient/family needs, utilizing the nursing process, coordinating the Plan of Care with the Interdisciplinary Team (IDT), and providing clinical, palliative and supportive care to the patient/family unit in order to keep the participant in their home environment as long as possible./ph3Job Description/h3pQualifications:/pulliCurrent license as RN in the state where the employee will be working/liliMinimum of one (1) year nursing experience; hospice or hospital experience preferred/liliEmployees working at PACE, certification of completion of Alzheimers Disease and Related Dementias Training through the Florida Department of Elder Affairs/liliPrevious experience working with an EMR/EHR (Electronic Medical/Health Record) system/liliMobile Driver - Valid drivers license and automobile insurance per Company policy/liliReliable transportation to meet visit schedule/liliAbility to use equipment with visual and auditory mechanisms/liliAbility to effectively communicate in English (verbal and written)/liliAbility to visit Participant in their homes to assessments/liliAbility to perform the essential functions and physical requirements (including, but not limited to: lifting patients and/or equipment, bending, pushing/pulling, kneeling) of the job with or without reasonable accommodation/liliActive BLS for healthcare professionals from the American Heart Association or Red Cross./li/ulpSome locations may require:/pulliProvides reassurance on the phone to patients and families. Assists in finding solutions to their questions and/or recognizes the need for an in person visit. Coordinates in person visit when needed/or requested./liliUtilizes appropriate support/expert resources or personnel to resolve complex or difficult situations./liliDocuments patient/family contact information in the EMR and communicates with the Interdisciplinary Team (IDT)./liliCompletes initial and semi-annual assessment for all Company services including, but not limited to:/liulliExplains services to patients/families and addresses questions regarding patient needs, fears, physical limitations, while putting the patient/family at ease; presents services in an empathetic and compassionate manner/liliProvides information to Physicians and other IDT members and initiates Plan of Care to address patients immediate needs/liliInitiates skilled nursing interventions to enhance prevention, prevent complications, alleviate symptoms and maximize physical and emotional comfort/liliObtains Physician orders/liliCompletes documentation per Company policy/li/ulliActs as the Company representative at assigned facilities while facilitating referrals to all service lines; works closely with referring hospitals, physicians, facilities, patients, families, and the general public./liliCommunicates frequently with other members of the IDT./liliProvides all necessary clinical communication timely using SBAR./liliDiscusses any potential needs with after-hours staff./liliDevelops strong relationships with case managers, physicians, etc. at facilities./li/ulh3Competencies/h3pSatisfactorily complete competency requirements for this position./ph3Responsibilities of all employees/h3pRepresent the Company professionally at all times through care delivered and/or services provided to all clients. Comply with all State, federal and local government regulations, maintaining a strong position against fraud and abuse. Comply with Company policies, procedures and standard practices. Observe the Companys health, safety and security practices. Maintain the confidentiality of patients, families, colleagues and other sensitive situations within the Company. Use resources in a fiscally responsible manner. Promote the Company through participation in community and professional organizations. Participate proactively in improving performance at the organizational, departmental and individual levels. Improve own professional knowledge and skill level. Advance electronic media skills. Support Company research and educational activities. Share expertise with co-workers both formally and informally. Participate in Quality Assessment and Performance Improvement activities as appropriate for the position./ph3Job Responsibilities/h3pProvides and manages direct care to patients and families as part of Interdisciplinary Team (IDT), incorporating psychosocial, spiritual, cultural, physical and biological components, and appropriate nursing intervention and follow-up. Coordinates the Plan of Care, ensuring that an individualized Plan of Care is developed that accurately reflects the patients evolving needs. Educates patient, family, caregivers and other health professionals about disease process and decline, prevention, palliative interventions, care giving, dying process and safety practices./ppParticipant visit frequency dependent on risk score/needs to be determined. Home visits to assess home safety, medication compliance, nutritional compliance, DME compliance- ability to live safely in the community. Reports changes in the patients condition to appropriate members of the IDT or other health professionals. Participates with the IDT to evaluate hospice referrals/admissions for level of care appropriateness./ppAttends daily IDT collaboration meetings. Presents concise and pertinent oral and written reports to IDT; respects and encourages input from all disciplines. Communicates accurately and completely to physicians, staff members, patients, families, and supervisors; utilizes positive approaches when working with others. Supervises patient care provided by Community Health Workers and Home Health Aides as requested./ppDuring times of emergencies (i.e. Hurricanes, etc.), the RN, Case Manager may be required to report to work at a location designated by the company, to ensure continuity of services. This may include reporting to work ahead of your scheduled date/time due to planned lock down of unit, and staying overnight(s) based on duration of emergency. Performs other duties as assigned./ppPhysical Demands for Post Offer/Pre-Placement (The demands described below are representative of those that must be met by an individual to perform the essential functions of the job, with or without reasonable accommodation.): While performing the duties of this job, the following abilities are required: see; hear; talk; walk; use hands to finger, handle or feel. Frequently required to: stand; sit; reach with hands/arms; lift; bend; balance. Occasionally required to: pull; push; stoop/crouch; kneel; climb stairs./ppCompensation Pay Range:/pp$69,720.00 - $103,771.25/ppThis position requires consent to drug and/or alcohol testing after a conditional offer of employment is made, as well as on-going compliance with the Drug-Free Workplace Policy./ppAll Chapters Health System employees performing services for Florida affiliates are submitted through the Florida Care Provider Background Screening Clearinghouse to verify eligibility after a conditional offer of employment is made as well as ongoing eligibility. For more information, please visit