RN Case Manager

Job Description

Job Description

Description:

Who We Are Frontier Home Health provides exceptional home healthcare services in Pueblo, El Paso and Fremont counties in Colorado. We are committed to delivering high-quality patient care, fostering strong community relationships, and maintaining a positive staff culture while adhering to the highest compliance standards. Collaborating with physicians, hospitals, and care facilities, we provide comprehensive support and enhance the quality of life for our patients. Recognized locally in Pueblo as a top home healthcare agency in 2025, we take pride in making a meaningful impact in the communities we serve. Full-time candidates are eligible for a $5,000 bonus!
Position Summary: The Registered Nurse provides skilled nursing care to patients in their home in accordance with the physician’s orders, established plan of care, and Agency policies. The RN collaborates with the interdisciplinary team, including the Registered Nurse Case Manager, physicians, patients, families, and caregivers, to support continuity of care and positive patient outcomes. The RN delivers care in compliance with CMS Conditions of Participation (42 CFR Part 484), accreditation standards, applicable State and Federal regulations, and Agency policies and procedures.
Duties and Responsibilities

• Provides skilled nursing services in the patient’s home as outlined in the established plan of care.
• Assesses and documents the patient’s physical, psychosocial and environmental needs during each visit.
• Reassesses patient condition on an ongoing basis and reports findings to the RN Case Manager.
• Performs age-specific nursing care in accordance with standards of practice.
• Identifies changes in patient condition and communicates promptly to the Case Manager and physician.
• Implements physician orders and nursing interventions as prescribed.
• Provides skilled nursing services requiring substantial and specialized nursing skills.
• Performs all patient care activities in a manner that promotes patient safety and reduces the risk of errors.
• Implements appropriate pain management interventions.
• Educates patients and families on pain management strategies.
• Demonstrates knowledge of medications, including safe administration, monitoring, and patient education based on patient age and clinical condition.
• Communicates changes in patient condition, concerns, or significant findings to the Case Manager and physician.
• Follows up on laboratory results and notifies the physician of significant or abnormal findings in accordance with Agency policy.
• Collaborates with the interdisciplinary team to ensure continuity and consistency of patient care.
• Completes clinical documentation and progress notes at the time of visit or within Agency-defined deadlines.
• Ensures documentation is accurate, timely and compliance with regulatory and Agency requirements.
• Demonstrates knowledge of current Federal, State, Agency and CHAP accreditation regulations related to patient care.
• Adheres to all Agency documentation, payroll, billing and compliance policies and procedures.
• Participates in discharge planning in collaboration with the patient, caregiver and RN Case Manager.
• Identifies ongoing care needs and assists with referrals to alternative levels of care as needed.
• Supports safe transitions of care throughout the episode.
• Participates in case conferences and team meetings to discuss patient progress, care needs and plans for continued care with 80% attendance.
• Coordinates with the Case Manager to support supervisory visits for Home Health Aides and Licensed Practical Nurses in accordance with State, Federal, Agency and accreditation requirements.
• Initiates referrals to other disciplines and community resources as indicated.
• Obtains, coordinates and utilizes necessary supplies and durable medical equipment to provide care safely in the home.
• Demonstrates the ability to safely use durable medical equipment in the home environment.

Professional Requirements

• Maintains patient confidentiality and HIPAA compliance at all times.
• Demonstrates effective time management and organizational skills; provides patient visits as scheduled; completes patient care within the designated time
• Adheres to all Agency, payroll, billing and documentation policies and procedures.
• Demonstrates leadership capabilities and possesses the ability to relate well to staff and professionals.
• Completes annual education and maintains regulatory requirements.
• Represents the organization in a positive and professional manner. Adheres to dress code, appearance is neat and clean.
• Complies with all organizational policies regarding ethical business practices.
• Communicates the mission, ethics and goals of the organization.

Regulatory Requirements:

• Graduate of an accredited school of nursing.
• Current state licensure as a Registered Nurse.
• Two years of experience as a Registered Nurse, preferably in a Home Health Care setting.
• Current CPR certification, proof of Tuberculosis PPD given within the past 12 months, and Hepatitis consent/declination.
• Valid state driver’s license and reliable automobile. Proof of current automobile insurance.
• Full command of verbal and written communication skills.

Skills and Competencies:

• Comprehensive knowledge of the general nursing scope of practice and theory.
• Basic computer skills.
• Experience with EMR system usage, preferably KanTime.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position without compromising patient care.
• The ability to use durable medical equipment in the home.

Physical Demands:

• Ability to utilize durable medical equipment in a home setting.
• Ability to lift, move, or assist patients and medical equipment weighing 50 or more pounds.
• Prolonged standing and walking are required.
• Manual dexterity and hand-eye dexterity required.
• Ability to identify patient needs, make timely clinical decisions, and address the psychosocial needs of patients and families.
• Ability to communicate effectively in English, both verbally and in writing. Communication in additional languages is preferred.
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions of the position without compromising patient care.

Frontier Home Health, LLC is an Equal Opportunity Employer, and does not unlawfully discriminate in employment opportunities or practices on the basis of race, color, religion, sex, national origin, age, disability, ancestral, medical conditions, family care status, sexual orientation, or any other basis prohibited by law.