Home Health Registered Nurse (RN) Case Manager

Major Responsibilities:

Performs all scheduled visits and collaborates with members of the interdisciplinary team as necessary.

Conducts thorough physical, psychosocial and environmental assessments of assigned patients and updates plan of care where appropriate and as a result of visit finding. Follows a care plan, which identifies problems (nursing diagnosis) and evaluates outcomes within a certain time frame.

Communicates with physicians to confirm and update patient's plan of treatment that may be necessary as a result of assigned visits. Communicates those changes to the RN Case Manager.

Provides on-going assessment of patient response to treatments, medications and teaching and applies interventions as appropriate. Updates and revises care plan as indicated.

Partners with the RN Case Manager to provide discharge planning according to agency standards and utilizes interagency/system and community resources to assure continuity of care after discharge.

Accurately documents and updates patient records according to agency, state and federal guidelines.

Communicates problems to physicians and RN Case Manager, and clearly states plans, actions and goals so that changes are reflected as they occur.

Follows published policies and procedures and regularly monitors changes or additions to them.

Performs various patient positioning and transporting duties, which require lifting and pushing/pulling, while utilizing proper technique.

Must be able to demonstrate knowledge and skills necessary to provide care appropriate to the age of the patients served. Must demonstrate knowledge of the principles of growth and development over the life span and possess the ability to assess data reflective of the patient's status and interpret the appropriate information needed to identify each patient's requirements relative to his/her age-specific needs, and to provide the care needed as described in the department's policies and procedures. Age-specific information is developed further in the departmental job standards.

Licensure, Registration and/or Certification Required:

Registered Nurse license issued by the state in which the team member practices, and

Basic Life Support (BLS) for Healthcare Providers certification issued by the American Heart Association (AHA) upon hire unless department leader has determined it is not required, and

A valid driver’s license issued by the Division of Motor Vehicles Driver.

Education Required:

Completion of an accredited or approved program in Nursing

Experience Required:

Typically 1 year of experience in nursing.

Knowledge, Skills & Abilities Required:

Proficiency in clinical skills with the ability to work under direction and make sound judgments.

Excellent communication and interpersonal skills.

Ability to develop rapport and maintain positive, professional relationships with a variety of patients, staff and physicians.

Demonstrated ability to effectively make critical, independent decisions.

Good organization, prioritization and problem solving skills.

Ability to multi-task with frequent interruptions.

Physical Requirements and Working Conditions:

Must be able to sit, stand, walk, lift, squat, bend, reach above shoulders, and twist frequently throughout the workday.

Must be able to:
lift up to 50 lbs. from floor to waist.
lift up to 20 lbs. over the head.
carry up to 40 lbs. a reasonable distance.

Must be able to:
push/pull with 30 lbs. of force.
perform a sliding transfer of 150 lbs. with a second person present.

May be exposed to chemical and hazardous waste as well as blood and body fluids and communicable disease. Therefore, protective clothing and equipment must be worn as necessary. 

Must have functional speech, vision, hearing, and touch with ability to use fine hand manipulation skills for procedures/functions. 

Operates all equipment necessary to perform the job.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.