RN CASE MANAGER

Integritus Healthcare•Lee, MA

10h

About The Position

The RN Case Manager manages and delivers comprehensive home health services to patients in their residences, including OASIS assessments and development of plans of care, goals, and interventions in collaboration with primary care physicians. The role may also include telephone triage, problem-solving, patient, caregiver, and family education, advocacy, and support. The position works with patients, families, healthcare providers, and community resources to plan care and discharge. The RN Case Manager manages an assigned caseload within a team-based care model, prioritizes visits and communications, supervises home health aides, and provides on-call services to assigned patients and families. The role also involves accurate and timely documentation, participation in quality and safety activities, and attendance at staff meetings and in-services.

Requirements

One to two years of experience in health care.
Associate degree in nursing.
Current CPR certification.
Current Massachusetts Registered Nurse licensure.
Valid driver's license.

Nice To Haves

Experience in home health.
Bachelor's degree in nursing.

Responsibilities

Assess patient and family learning needs, styles, and limitations, and adapt information delivery accordingly.
Establish realistic goals and develop individualized plans of care in collaboration with patients, families, and healthcare team members.
Collaborate with patients, families, healthcare providers, and community resources in care and discharge planning.
Follow physician orders for assigned patients in accordance with patient care policies.
Reconcile medications consistently with patients and physicians.
Manage an assigned caseload effectively within the team-based care model.
Establish a daily work plan based on patient and family service priorities and overall area needs.
Promptly triage patient visits, messages, and phone calls according to priority and urgency.
Apply physical assessment and care-planning skills.
Supervise home health aides in accordance with state and federal requirements.
Apply knowledge of pharmacology, medication administration, and medication reconciliation.
Communicate and collaborate regularly with all disciplines in the home care setting, and promptly address critical needs or crisis interventions.
Complete documentation accurately and on time.
Perform on-call responsibilities and provide on-call services to assigned patients and families.
Participate in agency quality management and safety activities.
Participate in ongoing staff meetings and in-services.