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, and coordinates the disciplines involved in delivering quality, cost-effective, billable care through direct care and supervision under physician direction. The RN educates patients and family members, promotes patient safety, completes accurate documentation, and complies with applicable legal requirements and state scope-of-practice rules. The role provides skilled nursing care in patients’ homes across the assigned territory of Arlington, Alexandria City, Alexandria, Falls Church, Kingstown, Ft. Belvior, Lorton, and Mt. Vernon. The schedule is Monday through Friday, 8:30 a.m. to 5:00 p.m., with on-call requirements. The RNCM travels to scheduled patient visits and participates in case conferences, in-service training, and mandatory agency meetings. Additional duties may be assigned.

Requirements

At least one year of experience as an RN 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.
Compassionate and caring approach when working with patients.
Knowledge of nursing best practices and ability to make appropriate nursing judgments.
Ability to identify situations and handle them with an appropriate solution.
Detail-oriented and observant.
Disciplined work ethic, with the ability to prioritize and be timely.
Ability to follow directions and work as a team member.

Nice To Haves

Home care experience is desired.

Responsibilities

Oversee patient care from the beginning to the end of the episode.
Update physician orders in the patient chart and notify the physician 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, develop individualized plans of care, and adjust them as patient needs change.
Administer medication as prescribed by the physician.
Help reduce re-hospitalizations 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 about disease or injury processes and how to manage them; listen to patients and family members and involve them in developing the plan of care.
Oversee and supervise patient care provided by nurse aides and LPNs; evaluate treatments and medical condition against the plan of care and determine whether the level of care meets patient needs.
Communicate supervisory visit results to LPNs and nurse aides.
Complete clinical documentation according to agency protocol and Medicare/Federal guidelines, including documentation of treatment, assessments, and patient education.
Document subsequent, discharge, evaluation/recertification, and resumption-of-care visits within 24 hours; document start-of-care visits within 24 hours; submit all required documentation within company timeframes.
Maintain an active RN license and follow the plan of care within the Registered Nurse scope of practice.
Communicate schedule 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 patients’ primary locations for scheduled visits, attend assigned visit locations daily, and fulfill RN visits in the assigned geographic area according to patient needs and federal and state specifications.
Perform other duties as assigned.