Registered Nurse (RN) Case Manager – Home Care (LHCSA)

Angels In Your Home•Town of Greece, NY

30d•Onsite

About The Position

The RN Case Manager is responsible for completing initial and ongoing nursing assessments, supervising Home Health Aides/PCAs, developing and updating individualized care plans, and ensuring safe, high-quality care for clients receiving non-skilled home care services. This position focuses on assessment, evaluation, education, and regulatory compliance — not hands-on skilled nursing procedures.

Requirements

Associate Degree in Nursing (ASN) required
Active New York State Registered Nurse (RN) license.
Strong assessment, communication, and documentation skills.
Knowledge of LHCSA regulations, MLTC requirements, care plan development, and supervision standards.
Valid NYS driver's license and reliable transportation.
Ability to work independently, manage a field-based schedule, and maintain professionalism in varied home environments.

Nice To Haves

Bachelor of Science in Nursing (BSN) preferred
Experience in home care, community health, case management, or related setting preferred (LHCSA experience ideal).

Responsibilities

Conduct initial in-home assessments for all new clients, including evaluation of: Medical/functional history as it relates to the care plan ADLs, cognition, safety, home environment Risks, equipment needs, caregiver support, and overall ability to remain safely at home
Complete 90-day, 6-month, and annual reassessments per DOH and payer requirements.
Identify any changes in condition and coordinate follow-up with appropriate providers or care managers.
Determine the need for Home Health Aide/PCA services and the appropriate frequency/scope of tasks.
Develop and maintain an individualized Plan of Care (POC) aligned with the patient's needs, goals, and authorized services.
Update care plans whenever the patient’s condition or needs change.
Educate patients and caregivers regarding safe home care practices, disease awareness, ADLs, emergency planning, and community resources.
Conduct supervisory visits in the patient’s home to evaluate: Quality of aide performance Compliance with the care plan Patient satisfaction and safety
Provide coaching, teaching, and corrective guidance to PCAs/HHAs as needed.
Document all supervisory contacts in accordance with DOH requirements.
Communicate with service coordinators, schedulers, MLTC care managers, physicians’ offices, and family members to ensure seamless care delivery.
Report significant changes in condition promptly to appropriate parties.
Participate in case reviews and quality improvement initiatives.
Complete accurate, timely electronic documentation in accordance with DOH, Medicaid, MLTC, and agency standards.
Maintain knowledge of New York State LHCSA regulations, infection control requirements, and payer guidelines.
Ensure all care delivery is compliant with the care plan, authorized tasks, and scope-of-practice restrictions for LHCSAs.