Home Health RN Case Manager

CenterWell•Overland Park, KS

1d•$77,200 - $106,200

About The Position

The Home Health RN Case Manager provides admission, case management, follow-up skilled nursing visits, and ongoing care for home health patients. The nurse develops and revises treatment plans in consultation with physicians, based on physician orders, initial and ongoing patient assessments, and applicable policy and regulations. Under the Clinical Manager’s supervision, the role includes hands-on patient care, care-plan evaluation, and patient teaching. The position coordinates care with healthcare personnel and external providers, keeps physicians and the Clinical Manager informed about patient condition and progress, and works with patients and families to address care needs. It also oversees home health aides, certified home health aides, and personal care workers; provides and updates written care instructions; and monitors their documentation. The RN discharges patients in consultation with the physician and Clinical Manager and prepares and maintains clinical records, reports, conference documentation, medication-order updates, recertifications, progress updates, and care-plan changes. The role is patient-facing and requires TB screening if selected. It participates in Humana’s driver safety program and requires a valid state driver’s license and personal vehicle liability insurance meeting the applicable minimum limits.

Requirements

Diploma, associate degree, or bachelor’s degree in nursing.
At least one year of nursing experience.
Strong medical-surgical, ICU, ER, or acute-care experience.
Current and unrestricted Registered Nurse licensure.
Current CPR certification.
Strong organizational and communication skills.
Valid driver’s license, auto insurance, and reliable transportation.
Maintain personal vehicle liability insurance in accordance with the residing state's minimum required limits or the stated alternative minimums, whichever is higher.
Complete TB screening if selected for the patient-facing role.

Nice To Haves

Home Health experience.

Responsibilities

Provide admission, case management, follow-up skilled nursing visits, and ongoing care for home health patients.
Provide necessary follow-up as directed by the Clinical Manager.
Develop an initial treatment plan with the physician based on physician orders and the initial patient assessment.
Provide hands-on care, manage and evaluate care plans, and teach patients in accordance with physician orders and under Clinical Manager supervision.
Revise care plans in consultation with physicians based on ongoing assessments and applicable policy and regulations.
Coordinate appropriate care with healthcare personnel, including physical therapists, occupational therapists, home health aides, and external providers.
Continuously report patient care, condition, and progress to the physician and Clinical Manager.
Implement the patient care plan with patients and families to help resolve needs and problems.
Coordinate, oversee, and supervise home health aides, certified home health aides, and personal care workers.
Provide written personal care instructions and care plans reflecting the current plan of care, and monitor aides’ and workers’ documentation.
Discharge patients after consultation with the physician and Clinical Manager, completing required clinical documentation.
Prepare and maintain medical documentation, including case conferences, patient contacts, medication order changes, recertifications, progress updates, and care-plan changes.
Prepare visit or shift reports, update and summarize patient records, and confer with other healthcare disciplines to support optimal patient care.