Home Health Registered Nurse

Cantex Continuing Care Network•Houston, TX

About The Position

The RN Case Manager supervises and manages patient care, including LVN and HHA supervision, case conferences, and discharge planning. The role helps identify patients’ medically related social and emotional needs, promotes their potential during a home health episode, and collaborates with physicians, the clinical team, and patients to prepare for discharge. The service area is Conroe, Texas, including Spring and The Woodlands.

Requirements

Registered Nurse licensed according to state requirements.
Good communication skills.
Assessment skills.
Strong clinical documentation skills.
Ability to read, write, and speak English.
Reliable transportation.
Valid and current auto liability insurance.

Nice To Haves

Two years of home health experience.
HomeCare HomeBase experience.

Responsibilities

Supervise and manage all aspects of patient care, including LVN and HHA supervision.
Coordinate the distribution of visits among nursing, physical therapy, occupational therapy, speech therapy, medical social work, and home health aide disciplines after Start of Care, Recertification, or Resumption of Care, and coordinate the plan of care with the physician.
Ensure that all visits are provided as ordered.
Initiate referrals to appropriate ancillary services, such as podiatry and community services.
Facilitate interdisciplinary communication to clarify patient needs and service expectations and support effective service delivery and patient progress.
Lead weekly interdisciplinary case conferences for the patient caseload and contribute to patient care plans.
Establish social action plans and realistic goals consistent with each patient’s medically related social and emotional needs.
Work with the Administrator to interpret and promote patients’ rights and the Patients’ Bill of Rights.
Coordinate discharge planning with patients, the clinical team, and the agency.
Provide individual and group support to patients and families during adjustment, crisis, or particular need.
Complete required documentation, including assessments, evaluations, visit notes, and discharge records, in accordance with state and federal regulations.
Function as a team leader and role model.
Serve on committees as requested by the Administrator.
Review and follow TheraCare Home Health Clinical Policies and Procedures on Abuse Prevention and enforce the employee responsibilities described in them.
Help assure patient safety.
Perform other duties and tasks as assigned.