RN Case Manager

RN Case Manager

The ADON/Case Manager position assists with the day-to-day management of the nursing department by collaborating with the Director of Nursing to plan, organize and direct the Nursing Service of Colonial Manor Nursing Home. The ADON/Case Manager works under the general supervision of the Director of Nursing, assumes responsibility for the Nursing Department in the absence of the Director of Nursing and, at times, serves as the charge nurse, the RN on-call, or the person in charge of Colonial Manor. Is prepared by virtue of education and experience to plan, direct and/or give nursing care to assigned residents. Evaluates and promotes total resident care (physical, emotional, psychological, social and spiritual). Participates with all other departments in planning and implementing the nursing component of care and assists in the evaluation processes. Endorses the team concept of providing care through the various disciplines and assumes 24-hour accountability for the function of the unit including the delivery of nursing care, and for the nursing actions of employees: RN's, LPN's, TMA's and CNA's.

Skills/Qualifications:

• Graduate of RN Nursing Program approved by State Board of Nursing. Has current RN licensure in Minnesota.
• Demonstrates leadership ability.
• Is skilled in oral and written communication.
• Possesses the ability to collaborate effectively with other health professionals, including community health care agencies.
• Capable of working closely with other departments within Colonial Manor in furthering the team concept of Long-Term Care.
• Possesses ability to communicate effectively with family members of residents and promotes a homelike atmosphere throughout the facility.
• Possesses strong communication, time management, and prioritizing skills.
• Demonstrate ability to assess the physical, emotional, spiritual and psychosocial status of the residents and to plan/implement nursing care.
• Has teaching skills and is willing to teach and promote education.
• Keeps up to date on new developments in geriatrics and gerontological nursing through continuing education and readings.
• Knowledge of state and federal regulations regarding Long Term Care or the ability to learn state and federal regulations.
• Knowledge of insurance or the ability to learn the variety of insurances used in Long Term Care, such as Medicare and the guidelines of qualifications
• Must possess leadership skills, have the ability to make sound decisions and work under pressure.
• Self-driven and detail-oriented to complete daily tasks.

Functions (Accountabilities): The ADON/Case Manager directs and provides professional nursing care consistent with the philosophy, policies and procedures of Colonial Manor Nursing Home, and with the Standards of Gerontological Nursing Practice. Does performance appraisals of Nursing Staff when needed, in collaboration with and supervision by the Director of Nursing. Assists with developing and maintaining resident care plans. Participates in Infection Control, Quality Assurance, Pharmacy, Resident Care, Nursing Services, Policy/Procedure, Admissions/Discharge, and other responsibilities as assigned.

Tasks Performed:

• Helps to develop and implement care plans through collaboration with residents, family and nursing team.
• Update Care Plan as needed and communicate to appropriate team members.
• Assures that nursing personnel caring for residents under her/his case management are following the resident's care plan. Does teaching of staff of correct procedures.
• Collaborate with Charge Nurse daily; Utilize nursing process to assess residents' status with a change of condition or concern identified.
• Implement a plan of action based on assessment criteria as needed and communicate with resident physician via fax or phone as needed.
• When needed, investigate/implements resident fall and incident reports efficiently and thoroughly to prevent more occurrences.
• Collaborates with Director of Nursing and Administrator on resident incidents bringing concerns/issues to the following meetings, IDT, QA, QAPI, Falls to assure that all incidents/safety needs are met within the facility.
• In absences of MDS coordinator, or when assigned, will be responsible for attending Care Conferences.
• In absences, may have to fill in as Charge Nurse, CNA, TMA to meet resident needs.
• Review/Change/Implement new policies and procedures, in collaboration with the Director of Nursing.
• Assist with Quality Assurance, QAPI, GDR Review, and Falls Program/Meetings within the facility.
• Responsible for initiating nursing staff discipline and/or education by following the chain of command; confers with Director of Nursing regarding problems.
• Participates in education plans for nursing services. Communicate with Education Coordinator any/all education/re-education of nursing staff persons.
• Collaborate with Director of Nursing to evaluate staff performance. Recognizes staff strengths and works toward improving their weaknesses.
• Follows standards of nursing practice. Lead by example with the staff he/she works with.
• Motivates staff to provide quality care for the residents which reflects the mission and core values of Colonial Manor.
• Provides input to Director of Nursing concerning supplies, equipment, and may order supplies as needed or as requested by Director of Nursing.
• Ensure state and federal guidelines are being met within the facility.
• Assists with weekly and intermittent lab draws, documenting in resident's' chart and communicating results with physicians when appropriate.
• Thoroughly review pharmacy consult reports assuring recommendations are completed before the next visit from pharmacy consultant.
• Assists with completion of resident assessments and implementation of interventions as required or delegated. (IE: MDS required assessments; change of condition, etc.)
• Collaborates with facility's infection Preventionist and Director of Nursing to monitor, evaluate, revise, and collect and interpret data for the facility's Infection Control Program.
• Assists with monthly diabetic fingernail and toenail care and podiatry rounds when needed.
• Destroys narcotic medications with pharmacy consultant monthly.
• Assists with expired/unused medication destruction at the facility.
• Assist with Minnesota Department of Health while in facility during survey.
• Assist Director of Nursing and Administrator with any regulatory survey that visits Colonial Manor.
• Will participate in the plan of corrections, education and training as it relates to survey results.
• Aware of good customer service and demonstrates the use of it.
• Uses quality management skills and leadership skills to fulfill the mission of Colonial Manor Nursing Home.
• Participates in department head meetings and communicates all pertinent information regarding resident care to other departments as each resident's health status/condition changes.
• Attend IDT stand-up daily follow up on clinical concerns bring resolutions to the IDT
• Assist with physician rounds at facility by scheduling visits, completing pre-visit paperwork, rounding with physician, completing any orders, obtaining progress notes, and documenting in the resident's chart.
• Complete weekly wound rounding and documentation, in collaboration with the Wound Care Team. (Certified Wound Nurse, Case Manager and Charge Nurse). Maintain accurate records of wounds (e.g. charting, measurements, physician notifications etc.) Update Matrix with treatment changes.
• Complete rounding with psychiatric physician on monthly psych rounds, prepare resident medical record for monthly psych rounds, and may also complete follow-up documentation of psychotropic medication with new admits, increases and decreases and retrieve consent from resident/representative for new or increased psychotropic medications.
• Adhere to Colonial Manor's Mission and Core Values
• Attend and participate in all required scheduled training, orientations, and education.
• Will participate in quality improvement processes
• Perform other related duties as assigned by DON, Administrator or another leader.

Admits:

• Thoroughly review potential resident medical information received from hospital for possibility of meeting residents' needs timely
• Ability to call the referring hospital to gather further information on resident status. (Wounds, IV's, tube feeding, behaviors, etc.)
• Facilitate admission from beginning to end.
• Assure that the resident room is ready, obtain any equipment as needed.
• Fax physician for admission orders, standing orders, Medicare certification, and any changes.
• Input resident information and orders into EMR and resident chart.

Discharge:

• Participate in discharge planning meetings.
• Facilitate discharge from beginning to end.
• Request discharge orders from appropriate physician.
• Prepare and review discharge instructions with resident/representative, including list of current medications and any orders.
• Order resident discharge medications from pharmacy of choice.