Registered Nurse (RN) - Case Manager - Homecare

Registered Nurse (RN)

Responsible for the care planning, utilization of services, coordination of care, and the education of the interdisciplinary teams in the management of patient care services. Develops all patient care plans in collaboration with the physician and interdisciplinary team, providing patient centered care efficiently, effectively, with the best possible outcomes.

Functions as interventionalists in the home utilizing clinical expertise and problem solving to make recommendations to the physicians based on comprehensive physical, psychosocial, emotional, spiritual and bereavement patient assessments.

Implements the nursing process utilizing highly proficient assessment skills in the performance of Start of Care visits, post-hospital evaluations, patient re-certifications, discharges and supervisory visits.

Partners with the physician and the interdisciplinary team to develop the plan of care in collaboration with the patient.

Makes recommendations for efficient and effective utilization of resources to achieve positive outcomes by implementing clinical protocols during the admission visit as dictated by patient's diagnosis.

Initiates and responds to requests for changes in plans of care, determines appropriateness of change and whether or not the change would be considered a Significant Change in Condition, for which an OASIS is required.

Demonstrates ability to affect the behavior of others to follow the recommended alternatives to care which includes providing thorough instruction and disease management education to patients and/or caregivers as ordered by the physician.

Educates patients, families, and caregivers about disease process, community resource and recommended self care.

The individual must be able to work the hours specified. To perform this job successfully, an individual must be able to perform each essential job function satisfactorily including having visual acuity adequate to perform position duties and the ability to communicate effectively with others, hear, understand and distinguish speech and other sounds. These requirements and those listed above are representative of the knowledge, skills, and abilities required to perform the essential job functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions, as long as the accommodations do not cause undue hardship to the employer.

Required Education, License/Certification, or Work Experience:

• Registered Nurse (RN) - Board of Nursing Upon Hire

Preferred Education, License/Certification, or Work Experience:

• 1-3 years in home health or hospice

Commitment to the daily application of Avera's mission, vision, core values, and social principles to serve patients, their families, and our community.

Promote Avera's values of compassion, hospitality, and stewardship.

Uphold Avera's standards of Communication, Attitude, Responsiveness, and Engagement (CARE) with enthusiasm and sincerity.

Maintain confidentiality.

Work effectively in a team environment, coordinating work flow with other team members and ensuring a productive and efficient environment.

Comply with safety principles, laws, regulations, and standards associated with, but not limited to, CMS, The Joint Commission, DHHS, and OSHA if applicable.

Avera is proud to offer a wide range of benefits to qualifying part-time and full-time employees. We support you with opportunities to help live balanced, healthy lives. Benefits are designed to meet needs of today and into the future.

• PTO available day 1 for eligible hires.
• Up to 5% employer matching contribution for retirement
• Career development guided by hands-on training and mentorship