About The Position

This position serves a case management role, responsible for an assigned group of patients, typically geographically related and accountable for the oversight and overall management of the post-acute services in the home setting. The role includes providing direct patient care and supervision of LPNs and HHAs in accordance with an established plan of care to address the patient needs, individual goals, and physician ordered services. The position is responsible for care coordination with the assigned multi-disciplinary team and acts as the assigned patient's liaison with other related healthcare providers in the continuum of care. Ensures appropriate, qualified, and timely patient care and documentation in order to meet patient needs and agency financial, operational, and quality goals.

Requirements

  • Graduate from an accredited School of Nursing.
  • BSN preferred.
  • BLS required per policy guidelines.
  • Current RN license or temporary license as a Registered Nurse Petitioner in the state in which you work and reside.
  • If declaring a National License Compact (NLC) state as your primary state of residency, meet the licensure requirements in your home state.
  • For Non-National License Compact states, current RN license or temporary license as a Registered Nurse Petitioner required in the state where the RN works.
  • Additional education, training, certifications, or experience may be required within the department by the nurse leader.

Responsibilities

  • Responsible for the daily management of an assigned patient caseload, ensuring timely care and documentation to meet the patient needs/services as prescribed in the established plan of care and per MD orders.
  • Collects data pertinent to the healthcare consumer's health or the situation from patient assessments in the home setting, telephonic contacts and/or related EMR information available.
  • Analyzes the data to determine the issues and available resources to seek effective resolution.
  • Identifies patients at high risk for re-hospitalization, falls and/or high utilization of resources that require additional intervention and case conferencing to ensure appropriate care and frequency of services mitigates risk and ensure high quality outcomes.
  • Prioritizes multi-issue situations appropriate to the criticality of patient health and welfare, patient/staff safety and impact to effective, timely services.
  • Identifies barriers to situation/complaint resolution and follows-up with the appropriate resources or leadership to address timely and effectively.
  • Develops and provides oversight of a plan of care that is effectively communicated with the parties involved and supports quality patient outcomes and patient satisfaction.
  • Implements the identified plan, and directs the care coordination of a multidisciplinary clinical team approach, supervision of LPNs and/or HHAs involved in the care of the assigned patient caseload to promote health and safe outcomes.
  • Performs ordered treatments, therapies, and/or procedures in accordance with State Nurse Practice Act and Home Health Conditions of Participation, JCAHO and agency policy and procedures.
  • Evaluates progress towards attainment of patient centered goals.

Benefits

  • Paid Time Off programs
  • Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
  • Flexible Spending Accounts for eligible health care and dependent care expenses
  • Family benefits such as adoption assistance and paid parental leave
  • Defined contribution retirement plans with employer match and other financial wellness programs
  • Educational Assistance Program

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What This Job Offers

Job Type

Full-time

Career Level

Entry Level

Industry

Hospitals

Education Level

Bachelor's degree

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