RN Case Manager, Home Health

RN Case Manager, Home Health Palm Coast Responsibilities Conduct comprehensive nursing assessments of patients' physical, emotional, psychosocial, and spiritual needs during admission, resumption of care, recertification, and discharge. Develop, implement, revise, and evaluate individualized Plans of Care in collaboration with patients, families, physicians, and the interdisciplinary team (IDT). Deliver direct skilled nursing care, including wound care, medication administration and management, IV therapy, injections, symptom management, and patient/caregiver education. Perform accurate and timely OASIS assessments to ensure proper reimbursement, quality reporting, and optimal patient outcomes. Educate patients and their families/caregivers on disease management, medication adherence, safety measures, self-care techniques, and strategies to prevent re-hospitalizations and promote independence. Supervise and direct LPNs/LVNs, home health aides, and other support staff to ensure coordinated, high-quality care delivery. Monitor patient progress, promptly identify changes in condition, and adjust care plans accordingly to optimize outcomes. Maintain accurate, timely clinical documentation in the Electronic Medical Record (EMR) system in compliance with agency policies, OASIS guidelines, and all regulatory/payer requirements. Actively participate in case conferences, interdisciplinary team meetings, and quality improvement initiatives. Manage a productive caseload with efficient visit scheduling within the assigned territory while ensuring continuity of care and exceptional patient experience. Respond to urgent patient needs and participate in on‑call rotations as required. Qualifications Must be RN Must have HH Leadership experience Must have OASIS experience with HCHB experience preferable Main point of contact for field clinicians Some Duties Include: Coaching and mentorship of clinicians, responsible for episode of care for patients, order approvals, facilitate case conference, Prep/perform utilization management review, review clinical notes, etc. Does have a team of clinicians reporting directly to them Graduate from an approved school of professional nursing and currently licensed to practice as a registered nurse in the state of agency operation. One (1) year experience as a RN. Required Certifications and Licensures Licensed to practice as a registered nurse in the state of agency operation. Must possess and maintain valid CPR certification while employed in a clinical role. Must be a licensed driver with an automobile that is insured in accordance with state and/or organization requirements and is in good working order. Ability to travel to all business locations. #J-18808-Ljbffr