Home Health RN Case Manager

Job Description

Job Description

Key Responsibilities:

• Takes charge of caseloads involving patients in specialized fields.
• Conducts comprehensive assessments to gather detailed physical, social, and environmental information.
• Develops a care plan based on physician directives and the individual needs of patients.
• Delivers direct patient care, modifying nursing processes as necessary. Identifies issues, adjusts the nursing care plan, and evaluates results within a suitable timeframe. Consults with families and other staff as needed.
• Continuously assesses patient responses to treatments and educational efforts, implementing interventions as required. Updates and revises care plans accordingly.
• Accurately and promptly completes documentation, including visit assessments, OASIS, 485 forms, and verbal orders, adhering to established standards.
• Engages with physicians to confirm and update patient care plans, providing status updates and ensuring ongoing communication with the healthcare team.
• Facilitates discharge planning in line with standards, utilizing resources to ensure continuity of care post-discharge. Collaborates with patients/families, physicians, social workers, and other staff in developing discharge plans.
• Participates in chart audits and continuous quality improvement initiatives as requested. Identifies and engages in opportunities for process enhancement to improve service quality.
• Maintains and updates precise clinical and patient records in compliance with agency, state, and federal regulations.
• Must demonstrate the necessary knowledge and skills to provide age-appropriate care. This includes understanding growth and development principles across the lifespan and the ability to assess and interpret data relevant to each patient's age-specific needs, in accordance with departmental policies and procedures.

Licensure, Registration, and/or Certification Requirements:

• Possession of a Registered Nurse license from the state where the individual practices.
• Basic Life Support (BLS) certification for Healthcare Providers from the American Heart Association (AHA) must be obtained within six months unless exempted by the department leader.
• A valid driver's license issued by the Division of Motor Vehicles is required.

Educational Qualifications:

• An Associate's Degree in Nursing is required.

Experience Requirements:

• A minimum of three years of clinical nursing experience is typically expected.

Knowledge, Skills & Abilities:

• Exceptional communication abilities, along with strong interpersonal skills to work effectively with diverse clients with patience and respect.
• Proven capability to collaborate positively with physicians and other professionals.
• Proficient clinical skills, with the ability to follow directions and make sound judgments.
• Competence in operating necessary equipment such as FAX machines, computers, copiers, and telephone systems.
• Ability to assess patient data and interpret information to identify specific patient needs.
• Must demonstrate tolerance for diversity and an appreciation for multiculturalism among patients and their families.
• Must possess a valid Driver License and have access to a registered, functional vehicle with adequate insurance coverage.

Physical Requirements and Working Conditions:

• Must have the manual dexterity to operate various equipment.
• Physical ability to navigate confined spaces, including bending, twisting, kneeling, squatting, and occasionally reaching overhead.
• Must be capable of safely working with individuals of varying sizes and weights, including those with complex medical conditions and physical limitations.
• Ability to sit, stand, walk, and climb stairs for both short and extended periods to complete paperwork, access patient residences, travel for visits, and participate in various work-related activities.
• Must possess the stamina to attend to patient care needs for three or more hours without complete rest.
• Must have accurate vision to read gauges and measuring devices and interpret written instructions.
• May be exposed to extreme temperature fluctuations due to weather conditions.
• May encounter chemical and hazardous waste as well as communicable diseases.
• Must be able to:
• Lift up to 50 lbs from floor to waist.
• Lift up to 20 lbs from waist to overhead.
• Lift and carry up to 40 lbs at waist height over reasonable distances.
• Push/pull with a force of 30 lbs.
• Perform a sliding transfer of 150 lbs with assistance from another person.

This job description outlines the general nature and level of work expected from the incumbent. It is not intended to be an exhaustive list of all activities, duties, or responsibilities that may be required. The incumbent may be asked to perform other related tasks as necessary.