Case Coordinator/SOC RN

$95,000 - $120,000/Yr

Visiting Nurse Service And Hospice Of Suffolk - Northport, NY

Full-time - Mid Level

Northport, NY

Ambulatory Health Care Services

About the position

The Case Coordinator/Start of Care RN is responsible for providing skilled professional services and case management oversight to home care patients. This role involves performing Start of Care assessments, ongoing case management, and ensuring comprehensive communication and coordination of care among healthcare personnel. The RN will manage a caseload of approximately 50 patients, focusing on patient-centered goals and effective resource utilization to avoid re-hospitalization.

Responsibilities

• Perform Start of Care and ongoing case management for home health patients.
• Provide comprehensive handoff to assigned field RN, including assessment findings and plan of care.
• Administer ongoing care and ensure necessary follow-up care is scheduled and completed.
• Confer with physicians to develop initial treatment plans based on assessments.
• Provide hands-on care and evaluate care plans in accordance with physician orders.
• Revise care plans based on ongoing assessments and regulatory requirements.
• Identify patient-centered goals and coordinate care with an interdisciplinary team.
• Project weekly home visit needs based on interdisciplinary team input.
• Conduct weekly progress reports with field RNs and other healthcare personnel.
• Ensure up-to-date charting and report patient progress to physicians and Clinical Manager.
• Discharge patients after consultation with physicians and Clinical Manager, ensuring clinical documentation is complete.
• Review nursing documentation and prepare visit reports, summarizing patient records.
• Adhere to infection control practices and agency policies.
• Utilize chronic disease management and health promotion strategies.
• Demonstrate OASIS proficiency and participate in care management meetings.
• Complete clinical documentation in a timely manner and request insurance authorizations.

Requirements

• New York State license and current registration as a registered nurse.
• Previous experience as an RN.
• Ability to comply with New York State regulatory requirements for patient care.
• Flexibility and ability to work well with others and autonomously.
• Strong therapeutic communication skills.
• Baccalaureate degree or higher in Nursing or related field preferred.

Nice-to-haves

• Experience with telehealth and chronic disease management strategies.
• Familiarity with Motivational Interviewing Techniques.

Benefits

• Competitive salary range of $95,000 - $120,000 per year.
• Full-time employment with potential for overtime on weekends and holidays.