RN Case Manager- Hospice-FT (Monmouth County)

Home Health Nurse

Responsible for providing professional nursing care to patients in their home through assessment, development, implementation and evaluation of home nursing care needs on an individual and continuous basis of assigned patients in accordance with organization policies and procedures and external regulations.

Assure compliance with appropriate physician orders in a timely manner and that visit frequency follows physician orders. Assure documentation reflects compliance with physician's orders and addresses progression to goals being met at discharge.

Assure that assessment, planning, intervention and evaluation of patient care follow policy, procedure, and standard of care. Demonstrate ability to care for a patient and significant other in a holistic manner. Assure safe patient care is provided. Demonstrate knowledge and competency in completion of assigned treatments and procedures according to established standards and policies. Utilize interdisciplinary team and accurately document all activities.

Assure clinical judgments and critical thinking reflect professional standards of care and codes of ethics which provide for safe and effective patient outcomes. Appropriately document clinical decisions through appropriate system.

Identify appropriate payors and remain in compliance with authorizations for self and other disciplines as necessary. Meet payor source guidelines. Maintain visit frequency with authorization range. Utilize secure messaging to insurance nurse for all authorizations.

Assure documentation of assessment, interventions and planning meet organization time lines. Complete nursing assessment, medication reconciliation and collaborate with physician on Plan of Care. Update care plan within two week period of change in patient status.

Implement specific teaching strategies to meet established goals on the plan of care. Assure documentation reflects appropriate teaching strategies in the medical chart that are consistent with goals and plans.

Report patient care problems to manager or appropriate nursing management personnel and/or physician in a timely manner with possible solutions. Assure documentation indicates case communication. Appropriately utilize manager as a resource.

Act as liaison among physician, Manager of Clinical Practice and other members of the health care team to ensure effective coordination and appropriate resource referrals. Assure that coordination of services is effective and meets client's needs.

Communicate pertinent patient information and Plan of Care during transfers of patient care loads, either on a daily basis or whenever vacation days/time-off are scheduled.

Complete routine assignments accurately, consistently and independently in a timely manner without the need for supervision. Meet productivity requirements on a consistent basis.

Act as clinical supervisor of para-professional home health aide staff. Complete supervisory visits within regulatory time frame and assure visits are documented. Participate in the evaluation of home health aide staff.

Maintain awareness of new/updated standards and incorporate these into nursing practice throughout continuum of care. Assure documentation in the medical chart demonstrates knowledge of current practices` guidelines.

Adheres to HMH's Organizational competencies and standards of behavior.

Lifts a minimum of 50 lbs., pushes and pulls a minimum of 50 lbs. and stands a minimum of 8 hours a day.

Education, Knowledge, Skills and Abilities Required:

• Associate's Degree in Nursing or Diploma Certificate in Nursing
• At least six (6) months RN experience or at least 1 year of LPN experience, preferably in home care or hospice
• PC Experience/Skills

Licenses and Certifications Required:

• NJ State Professional Registered Nurse License
• AHA Basic Health Care Life Support HCP Certification