Case Manager

Responsibilities Develop and evaluate individualized patient‑centered care plans under physician supervision. Provide case management to an assigned group of patients and ancillary staff. Understand and submit required data collection sets (OASIS, PAR, etc.) and other documentation as requested by state, federal government, and insurance payers within required timeframes. Make the initial evaluation visit and regularly reevaluate the patient’s nursing needs per state and payor requirements. Act as an advocate for patient welfare and coordinate care between patients, their families/caregivers, the agency, and other healthcare providers and facilities. Furnish services requiring substantial specialized nursing skill according to competency level. Demonstrate problem‑solving abilities and positive interpersonal communication skills. Identify care preferences of patients and verify interventions meet patients’ needs and goals of treatment. Initiate appropriate preventive and rehabilitative nursing procedures. Prepare clinical and progress notes for each patient visit and summaries. Attend case conferences as assigned. Inform physician and other personnel of changes in the patient’s condition and needs. Counsel the patient and family/significant others in meeting nursing and related needs. Educate on proper home health strategies and procedures utilizing community resources as applicable. Observe and report patient symptoms, reactions to treatments, drugs, and changes in the patient’s physical or emotional condition. Be responsible for medication reconciliation. Participate in in‑service programs, supervising and teaching other nursing personnel as assigned. Administer medication per agency policy and physician orders. Provide written instructions for aides or other ancillary disciplines caring for the patient. Process orders and notify physician of patient needs and changes in condition. Refer cases with physician’s orders to Physical Therapist, Speech Language Pathologist, Occupational Therapist, and Medical Social Worker when required. Understand and adhere to the policy and procedure, best practices, infection control plan, EMS plan, and the compliance plan. Participate in clinical record/utilization review of medical records and quality assurance and performance improvement (QAPI) quarterly and as assigned. Report/record all applicable infections, occurrences, and complaints. Submit documentation within 24 hours or per state requirements. Maintain confidentiality of patient, employee, and agency matters. Takes on‑call duty nights, weekends, and holidays, as assigned. When functioning as the on‑call RN, act as the after‑hours supervising nurse and make nursing assessment and triage decisions under guidance of the overall Clinical Supervisor as applicable. Immediately report to Nursing Supervisor any patient incidents/variances or complaints. Demonstrate competent performance of technical skills according to established procedures. Maintain acceptable attendance status, per Agency policy. Report all incomplete work assignments to Nursing Supervisor. Demonstrate effective time‑management skills through daily documentation and infrequent overtime for routine assignments. Ensure that the following information/instruction is given in writing to the patient/caregiver/representative: visit schedule with frequency of visits, complete medication profile, any treatments to be administered by agency staff (POC), any other pertinent instruction related to the patient’s care needs, name and contact information of the agency’s Clinical Manager. Perform all other duties as assigned. Required Skills, Abilities, and Knowledge Average computer skills with competency in media communications. Physical abilities to perform the described duties. Organize work procedures through time management, assume responsibility, and effectively supervise ancillary disciplines per state requirements. Secure transportation and travel as required. Apply professional training to critically think through patient needs, follow physician’s orders, and produce accurate records of nursing activity within agency guidelines. Acceptance of philosophy and goals of this Agency. Exercise initiative and independent judgment. Meet all health requirements for clearances and current CPR. Maintain licensure and continuing education as applicable. Excellent verbal and written communication. Education, Experience, Licenses, and Certifications Graduate of an approved school of professional nursing and currently licensed in the state(s) in which practicing. One (1) year nursing experience and home care (preferred). Benefits + Perks of Joining the Team Family Medical, Dental, and Vision Insurance Paid Time Off and Paid Sick Time 401(k) Referral Program Pay Range: $70,000 – $85,000 / salary with bonus Team Select Home Care reserves the right to change the above job description and qualifications without notice. Team Select Home Care will not discriminate against you on the basis of race, color, religion, national origin, sex, sexual preference, disability, political belief, veteran status, age, or any other status protected by law. Team Select Home Care is an employment‑at‑will employer. #J-18808-Ljbffr