Home Health RN Case Manager

Occupational Summary:

Work independently with groups of clients to provide initial and on-going assessment of the client’s skilled needs. Implement individual plans of care and make referrals to others disciplines and /or revise the plan, as necessary. Provide ongoing consultation and education for patient/family member regarding all aspects of care. Communicate and collaborate with family /caregivers and other professionals involved in the care of the client. Supervise Licensed Practical Nurses and Home Health Aides. Reports to the Home Health Manager.

DUTIES AND RESPONSIBILITIES

• Complete initial and ongoing comprehensive assessments of the client’s needs, including initiating the plan of care and revising as necessary
• Provide skilled nursing care services and/or treatments requiring substantial and specialized nursing skill, including intravenous fluids and medications, urinary catheterization, and complex wound care
• Counsel the client and family in meeting nursing and related needs
• Initiate appropriate preventive and rehabilitative nursing procedures
• Prepare clinical and progress notes
• Coordinate services involved in client’s care
• Make referrals to other services as needed
• Inform the physician and other staff of changes in the client’s needs
• Evaluate outcomes of care and complete the OASIS assessment accurately
• Supervise LPN/LVNs and Home Health Aides providing services
• Assign home health aides to a specific patient
• Participate in in-service programs
• Participates in quarterly chart reviews
• Plan for the discharge from service
• On-call and Holiday hours determined by Home Health Clinical Manager.
• Other job duties as assigned