Registered Nurse Case Manager, Level 2

21st Century Home Health Services•Sonoma, CA

6h•Remote

About The Position

At 21st Century Home Health Services (21HHS), we treat every patient with empathy, compassion, and understanding. As the largest home health agency in San Francisco and the fastest-growing in the Bay Area, we care for over 4,000 patients across multiple counties and are expanding. Our clinicians are dedicated to patients and each other, resulting in consistently low hospital readmission rates (under 10%) and high employee satisfaction, recognized by Top Workplace awards. We foster an environment of support, growth, and recognition through open communication and professional development. 21HHS attracts top clinical talent and delivers outstanding outcomes, cementing our place as a leader in home health. All opportunities require visiting patients in their homes.

Requirements

Minimum of one year of Nursing Experience required; two+ years preferred.
Current and unrestricted CA RN license
Current BLS/CPR Certification
Valid CA Driver's License
Experience working with an interdisciplinary team is required
Case Management fundamentals is required
Self-Directed
Empathetic
Critical thinker
Outstanding interpersonal skills
Leadership skills
Organized

Nice To Haves

One Year of Home Health Case Management experience is preferred
Experience supervising, mentoring Nurses is highly preferred
High level of clinical knowledge in home health care is key
Experience with high acuity patients is a plus

Responsibilities

Utilize outstanding clinical skills to create, implement, and execute the overall plan of care to promote wellness and prevent re-hospitalization for patients in their homes.
Provide oversight to 2 Nurses responsible for executing the care plan.
Conduct comprehensive patient assessments such as Start of Cares (SOCs), Evaluations, Resumption of Care, and discharge planning.
Assist and teach patients, their families, and caregivers with wound care, blood draws, tube feedings, Tracheostomy care, foley catheters, Congestive Heart Failure (CHF) management, and medication education in the patient's home.
Perform a full assessment of the patient & family upon initial visit.
Use assessment data to develop an advanced plan of care including rehabilitation.
Work with patients and family one on one to achieve improvement and/or stability.
Case manage patients' care episode with an interdisciplinary clinical team.
Prepare clinical notes, orders, and charting in a compliant timeframe.
Collaborate with physicians and agency staff to deliver the best care possible.

Benefits

401k with matching
Generous PTO
Medical
Dental
Life Insurance
Employee Assistance Program (EAP)
Flexible Spending Accounts (FSAs)
Pet Insurance
Concierge for Case Managers: Dedicated resources assist with time consuming administrative tasks
Flexible work schedules: Create your own schedule and hours
Autonomy: No clocking in/out
Opportunity for advancement. We have multiple tiers for RNs including Admission Nurses, RNI, RNII, RNII as well as clinical leadership and support opportunities.
Low turnover/High morale
Helpful software and communication tools
Competitive compensation with achievable incentive bonus program