RN - Home Healthcare - PRN

Home Health RN Case Manager

Provide compassionate, skilled nursing care in the comfort of patients' homes. Support recovery and independence through personalized health plans and education. Make a meaningful impact by delivering quality care where it matters most.

How you grow, learn and thrive matters here:

• Educational and career development options, including tuition and certification reimbursement, scholarship opportunities
• Staff Safety (a wearable badge that allows nurses to quickly and discreetly call for help when safety is a concern)
• Differentials for night/weekend shifts, higher education, certifications and various lead roles (for eligible positions)
• Malpractice liability insurance
• Loan forgiveness through the New Mexico Higher Education Department
• EPIC electronic charting system

Type of Opportunity: PRN

FTE: 0.00

Job Exempt: No

Work Shift: Days (United States of America)

Responsibilities:

• The Home Health RN Case Manager provides comprehensive nursing care and case management for patients in their homes and community settings. This role ensures that care delivery meets quality and utilization standards while achieving optimal clinical outcomes.
• Responsibilities include developing, coordinating, and scheduling individualized care plans through a multidisciplinary team, maintaining timely and accurate documentation, and serving as a patient advocate.
• The RN Case Manager communicates effectively with healthcare providers, support services, and community resources to deliver efficient, cost-effective care. Additionally, this position mentors newly hired nurses and plays a key role in ensuring compliance, continuity of care, and patient satisfaction.
• Ensures the quality and safe delivery of home health services.
• Completes assessments that are timely, and appropriate of physical, mental, psychological/social (behavioral), functional, financial, treatment, resource, and spiritual needs of patients.
• Provides skilled nursing care services by planning, organizing, directing, coordinating, evaluating, and documenting all aspects of nursing care in accordance with physician/APC plan of care.
• Coordinates patients care through collaboration with patient/care giver, multidisciplinary team, and physician/APC.
• Intervenes consistently and changes interventions with orders to meet changes with patient/caregiver needs.
• Evaluates each visit the effectiveness of interventions and the patients response to intervention.
• Provide direct patient care by assessing patient for care needs, resources to meet needs and developing a home care plan of care in conjunction with physician. Assures completion of required OASIS assessments according to regulations for home care and QAPI measures.
• Ensures plan of care is followed and that documentation complies with regulatory requirements.
• Maintains a department productivity standard for visits and caseload management.
• Demonstrates professional accountability for self-scheduling patient case load with appropriate frequency and duration, and concurrently updates schedule throughout the day as needed so that ongoing patient needs can be met.
• Assure patients on case load are notified timely of their visits, any unplanned schedule changes, and accommodate patients preferred schedule as available.
• Precepts newly hired nurses, students and serves as a resource person and professional role model as needed.
• Maintain communication with the multidisciplinary team s and assures that orders for necessary care plan changes are obtained and communicated timely to the team.
• Initiates documentation in the home and completely records all care delivery so that receiving staff have record of care delivered in a timely manner per agency policy and procedures.
• Oversight and delegation of the plan of care within the care team as appropriate to LPNs and CNAs.
• Assumes professional responsibility for current nursing practice and clinical standards of care.
• Participates in agency continuous quality improvement and process improvement project (PIP) activities as required.
• Assume other leadership roles as required by the department.
• Responsible for holiday coverage, select weekend coverage and evening call for agency and patient home visits as required on a rotating basis.
• Performs other functions as required.

Qualifications:

• Associates degree in Nursing required.
• New Mexico RN License required.
• BLS Required at time of Hire
• Must have current valid driver's license and auto insurance.
• Minimum 1 year in direct patient care setting or home healthcare preferred
• Direct Home Health Experience HIGHLY PREFERRED

Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.Compensation Disclaimer The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.

Presbyterian Healthcare Services