Fairfax Registered Nurse Case Manager

Alternate Solutions Health Network•Fairfax, VA

About The Position

The Registered Nurse Case Manager (RNCM) assumes accountability and leadership for assessing patient conditions and developing plans of care. The RNCM provides case management and clinical care, coordinates the disciplines involved in delivering quality, cost-effective, billable care, and provides direct care and supervision under the direction of the physician. The role includes educating patients and family members, promoting patient safety, maintaining accurate documentation, and complying with applicable legal requirements and state scope-of-practice rules. The position provides skilled nursing care in patients’ homes and oversees care throughout the episode, including assessments, coordination, medication administration, patient and family education, and supervision of nurse aides and LPNs. The RNCM works Monday through Friday, 8:30 a.m. to 5:00 p.m., with on-call requirements, and travels to scheduled patient visits in the assigned territory: Arlington, Alexandria City, Alexandria, Falls Church, Kingstown, Ft. Belvior, Lorton, and Mt. Vernon. Required visit documentation must be completed within 24 hours.

Requirements

At least one year of RN experience in an acute care setting.
Current Registered Nurse license in the state of employment.
Valid driver’s license and auto insurance listing the employee as a driver.
Ability to communicate effectively and create positive impressions with patients, families, physicians, and coworkers.
Ability to remain calm, patient, and accommodating, and to demonstrate compassion and care when working with patients.
Knowledge of nursing best practices.
Ability to make appropriate nursing judgments and identify situations and handle them with the best possible solution.
Detail-oriented and observant.
Disciplined work ethic and ability to prioritize and be timely.
Ability to follow directions and work as a team member.

Nice To Haves

Home care experience.

Responsibilities

Oversee the overall care of the patient from the beginning to the end of the episode.
Update doctor orders in the patient chart and notify the doctor of significant changes in the patient’s condition.
Manage multidisciplinary care as applicable.
Provide skilled nursing care in patients’ homes as ordered by the attending physician.
Observe and monitor patient conditions.
Perform OASIS assessments to develop individualized plans of care and adjust them as needs change.
Administer medication as prescribed by the physician.
Help decrease rehospitalizations by front-loading visits for high-risk patients and teaching patients preventative measures and sound decision-making.
Promote continuity of care through appropriate admissions, transfers, and discharges.
Counsel patients and families on disease or injury processes and how to manage them.
Incorporate patients and families in developing plans of care and listen to their concerns.
Oversee and supervise patient care provided by nurse aides and LPNs.
Evaluate treatments and the patient’s medical condition according to the plan of care, and determine whether the level of care meets the patient’s needs.
Communicate supervisory visit results to LPNs and nurse aides.
Complete clinical documentation in accordance with agency protocols and Medicare/Federal guidelines, documenting treatment, assessments, and patient education.
Maintain an active RN license.
Communicate changes outside the normal schedule to the scheduler.
Participate in on-call requirements and case conferences.
Attend in-service trainings and mandatory agency meetings.
Drive to the patient’s primary location for scheduled visits and attend assigned visit locations daily.
Document start-of-care, subsequent, discharge, evaluation/recertification, and resumption-of-care visits within 24 hours, and submit all required documentation within company time requirements.
Follow the plan of care within the scope of practice for a Registered Nurse.
Fulfill RN visits in the assigned geographic location according to patient needs and federal and state specifications.
Perform other duties as assigned.