Registered Nurse (RN) Case Manager

Alternate Solutions Health Network•Detroit, MI

About The Position

The Registered Nurse Case Manager (RNCM) is accountable for assessing patient conditions, developing and overseeing plans of care, and coordinating the disciplines involved in providing quality, cost-effective, billable care under physician direction. The RNCM provides skilled nursing care in patients’ homes, supervises care provided by LPNs and nurse aides, educates patients and families, and promotes patient safety and continuity of care. The role includes accurate, timely documentation in accordance with agency protocols and applicable legal, state, federal, and Medicare requirements. The schedule is Monday through Friday, 8:30 a.m. to 5:00 p.m., with three weekdays and two weekend days on call per month. The territory includes Warren, Hazel Park, Pleasant Ridge, Ferndale, Detroit, Highland Park, and Hamtramck. The RN travels to assigned patient locations and completes visits in the assigned geographic area.

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.
Compassion and care when working with patients.
Knowledge of nursing best practices and ability to make appropriate nursing judgments.
Ability to identify situations and handle them with appropriate solutions.
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.

Responsibilities

Oversee the patient’s care throughout the episode.
Update physician orders in the patient chart and notify the physician of significant changes in the patient’s condition.
Coordinate multidisciplinary care and provide skilled nursing care in the patient’s home as ordered by the attending physician.
Observe and monitor patient conditions, administer prescribed medication, and evaluate treatments and the patient’s medical condition against the plan of care.
Perform OASIS assessments, develop individualized plans of care, and adjust plans as patient needs change.
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 and listen to patients and family members about disease or injury processes and their management, and involve them in care planning.
Oversee and supervise care provided by nurse aides and LPNs, communicate supervisory visit results, and determine whether the level of care meets patient needs.
Complete clinical documentation, including documentation of treatments, assessments, and patient education, according to agency protocol and applicable Medicare and federal guidelines.
Complete documentation for subsequent, discharge, evaluation/recertification, and resumption-of-care visits within 24 hours, and start-of-care documentation within 24 hours.
Submit required documentation within company deadlines and follow the plan of care within the RN scope of practice.
Fulfill RN visits in the assigned geographic area according to patient needs and federal and state requirements.
Communicate schedule changes to the scheduler.
Participate in on-call requirements, case conferences, in-service trainings, and mandatory agency meetings.
Drive to patient locations and attend assigned visits.
Maintain an active RN license and perform other duties as assigned.