RN Case Manager In-Home Health Care & Care Coordination

Description

All About You Collaborative Health Care Services, LLC is growing! We are seeking a Full Time RN Case Manager to join our team for Naugatuck and the surrounding towns.

All About You Collaborative Health Care Services LLC, is a Nurse owned and operated, transitional home care agency! Come help us transition patients from hospital/facility to home and prevent rehospitalizations!! We are seeking Cardio/pulmonary, wound care specialists and RN's who are highly skilled either from the ED or ICU, to join our team to help us make a difference in the lives we serve. Our innovative group is a preferred provider for several local hospitals/facilities and Assisted Living Facilities. Our signature LIFE MAP is truly ALL ABOUT YOU.

As an employee of AAY, we view you as a person first, then an employee. We work as a team to achieve the patient's goals. One employee comments "I come to work and really love making a difference in the lives we serve in the community'. This place truly cares about their team and the patients."

JOB SUMMARY:

A Registered Nurse administers skilled nursing care to patients on an intermittent basis in their place of residence or Assisted Living Facilities. This is performed in accordance with physician orders and plan of care under the direction and supervision of the Director of Clinical Services/Supervisor of Clinical Services.

JOB DUTIES:

• The RN Case Manager ensures quality and safe delivery of nursing services to patients in the home setting, we bring the health resources home.
• The RN Case Manager makes the initial evaluation visit, works to develop, implement and evaluate the plan of care. They provide coordination of the plan of care, maintaining continuity of client care with other health professionals while identifying interdisciplinary care needs and making recommendations for additional home health care services.
• The RN Case Manager supervises the client care rendered by Licensed Practical Nurses and Home Health Aides in the provision of delegated duties and conducts supervisory visits per regulatory guidelines.
• The RN Case Manager demonstrates timely and accurate point of care on the EMR and submits timely documentation of patient information and reports change in condition timely to the SCS and the MD.
• The RN Case Manager prepares the clinical and progress note for each patient and summaries of case conferences for each patient in a timely manner as per agency policy. The RN works with the patient, their support system and the MD when developing a care plan, we see he patient beyond the illness and provides a patient centered care plan. The RN provides care plan development and care team oversight in the community with full back office and Supervisor support.

RESPONSIBILITIES:

• Provides services in accordance with the plan of care.
• Makes the initial evaluation visit and regularly reevaluates the patient's nursing needs.
• Initiates the plan of care and necessary revisions.
• Provides those services requiring substantial specialized nursing skills.
• Initiates appropriate preventive and rehabilitative nursing procedures.
• Prepares clinical and progress notes for each patient visit and summaries of care conferences on his/her patients in a timely manner as per Agency policy.
• Coordinates services.
• Informs personnel of changes in the condition and needs of the patient.
• Counsels the patient and family/significant others in meeting nursing and related needs.
• Participates in and presents Inservice programs.
• Understands and adheres to established Agency policies and procedures.
• Processes orders and notifies physicians of patient needs and changes in condition.
• Completes certification/recertification orders and discharge summaries with support from the back office.
• Determines the amount and type of nursing needed by each individual patient.
• Refers to Physical Therapist, Speech Language Pathologist, Occupational Therapist and Medical Social Worker those patients requiring their specialized skills.
• Supervises and teaches other nursing personnel.
• Conducts patient care conferences on patients assigned to his/her care.
• Gives total patient care as needed.
• Takes on-call duty, weekends and holidays, as assigned.
• Completes and submits OASIS assessments, reassessments, transfers, resumptions of care, discharges and significant change in condition in accordance with Agency defined time frames.
• Appropriately utilizes ICD-9/ICD-10 codes.
• Perform other duties as assigned.

WORKING ENVIRONMENT:

• Works indoors in the Agency's office, patient homes and travels to/from patient homes.

LIFTING REQUIREMENTS:

Ability to perform the following tasks if necessary:

• Ability to participate in physical activity.
• Ability to work for extended period of time while standing and being involved in physical activity
• Heavy lifting
• Ability to do extensive bending, lifting and standing on a regular basis

BENEFITS:

All About You Collaborative Health Care Services, LLC offers a competitive salary and benefits package to all full time employees.

• Medical, dental, and vision options
• Mileage reimbursement
• Monthly cell phone allowance
• Life Insurance 15k
• Generous paid time off
• Paid holidays
• 401(k) retirement plan

Come Join Our Growing Team!

This Company Describes Its Culture as:

• Innovative and collaborative
• People-oriented -- supportive and fairness-focused
• Team-oriented -- cooperative and collaborative
• Team building and ability for growth within the company
• Family oriented

Requirements

• Graduate of an approved school of professional nursing and currently licensed in the state(s) in which practicing.
• Two (2) years nursing experience, preferred but not necessary.
• Acceptance of philosophy and goals of this Agency.
• Ability to exercise initiative and independent judgment.
• Willing to train home care experience not necessary