RN Home Health Case Manager

Home Health Registered Nurse

Paid Mileage!!! Freedom at Home is a combat and service disabled veteran owned and operated small business that offers skilled home care services. Welcome to Freedom at Home! Freedom at home is looking to hire compassionate, dedicated, and hard working clinicians. Clinicians who value their work and take pride in what they do. Clinicians who want to work for a company that values them and their input. Caring for patients is more than just a job to us and we want clinicians who feel the same way. We are looking to be change agents in this industry. We will strive to be a 5 star agency and maintain that. We hold ourselves to the highest standard and we welcome anyone to join our team who does the same. Clinicians on our team are highly valued and highly rewarded. We work as a team to provide the highest quality of care and outcomes.

Job Summary

A professional who provides professional nursing services within the scope of nursing practice standards in collaboration with primary care physicians, teaches and educates patients and their families. Professional skilled nursing is performed under the supervision of the administrator/director of nursing.

Qualifications

Graduate of an approved professional nursing program (RN) Currently, licensed "in good standing" in MI Minimum of one (1) year of experience as a professional nurse, preferably in home care. Must have a criminal background check. Must have current CPR certification.

Responsibilities/Essential Functions

Furnishes those services requiring substantial and specialized nursing skill. Initiates appropriate preventative and rehab nursing procedures. Prepares & submits timely, clinical and progress notes. Oversees coordination of patient services. Informs MD and other staff of changes in PT situation or needs. Completes medical history/home safety check/environmental assessments. Performs socio-psychological evaluation. Performs assessment visit and documents timely. (ie. OASIS/ Skilled Nursing Note etc.). Performs physical examination and review of all body systems and documents accordingly. Develops individualized Plan of Care (POC) to be submitted to the physician for approval and implementation and performs necessary revisions based upon patient needs. Determines medical necessity for other services. Regularly re-evaluates the patient's nursing needs. Evaluates the patient's ADL and iADL abilities and need for home health aide. Develops and implements the HHA plan of care when HHA services are ordered. Revises and signs this care plan the beginning of each certification period. Supervises HHA in accordance with state/federal requirements and documents the supervision. Orders "other" professional services that may be appropriate to the needs. Reviews billing processes with patient and/or family advising patient and/or family when co-pay or Medicare is not likely to pay for services. Effectively communicates ongoing with patient and family progression/changes in POC. Effectively communicates with Supervisor/Nursing Director/other disciplines in the case. Communication with the patient's MD (verbally and/or in writing) to obtain effective treatment modalities and/or rehabilitative therapy modalities. Actively communicates in the case conferencing sessions to establish best practices. Submits requests for re-authorization of "more visits needed" to payers timely. Coordinates Community Services for the patient to assist in safe home care needs. Participates in the Performance Improvement Committee process.

Performs timely clinical record reviews (CRR) per Agency policy in collaboration with the Nursing Supervisor. Participates in ongoing staff meetings/in-services. Participates in the growth of office by being a willing preceptor for same discipline employees. Participates in the planning, operation and evaluation of the nursing services of the organization. Maintains professional licensure per state requirements. Notifies the Agency of emergencies, sickness, and other imminent occurrences that may affect the patient caseload as quickly as possible relative to the event's occurrence. Submits written time requests 2 weeks or more in advance of planned time off. Other duties as assigned.

Special Equipment To Be Operated

Vehicle to do routine patient visits, possible transfer/lifting devices, medical supplies

Work Environment

Indoors, performing patient care assessment/tasks in the patient's residence Travel to patient residences/meetings; will require transportation to get to various work sites Possible exposure to communicable diseases

Functional Abilities

Able to access patient's homes that may not be handicap accessible. Able to hear, speak, understand and communicate effectively in English.

Physical Requirements

On a daily basis: walking, standing, sitting, reaching, use of telephone, use of computers & other office equipment, lifting/transferring 150 lbs or greater, bending, stooping, climbing stairs.