RN Case Manager

All Heart Home Care•Nashville, TN

13d•Hybrid

About The Position

All Heart Home Care is seeking an experienced and compassionate RN to join our team as a Home Health Case Manager. This full-time position offers the opportunity to make a meaningful impact by coordinating and managing patient care from admission through discharge while helping patients maintain their independence in the comfort of their own homes.

Requirements

Current, valid, and unencumbered Tennessee license or Compact State licensure
Current BLS/CPR certification
Valid driver's license, reliable transportation, and current auto insurance
Minimum of two (2) years of home health experience required
Minimum of one (1) year of EMR experience required
Strong computer and documentation skills
Excellent communication, organizational, and customer service abilities
Self-motivated with the ability to work independently
Must reside in Tennessee and be able to attend in-office care conferences as needed

Nice To Haves

Passionate about helping patients remain safely at home
Takes pride in providing exceptional-not average-patient care
Thrives in an independent role while remaining a strong team player
Proactive, organized, and solution-oriented
Wants to grow their career with a company that values excellence, compassion, and integrity

Responsibilities

Prepare and manage PCC recertification and discharge (DC) forms
Prepare for and conduct PCC patient discussions; attach all required documentation to patient charts
Enter and process physician and nurse practitioner (MD/NP) orders
Communicate with clinicians and coordinate patient tests, treatments, and ongoing care
Collaborate with clinicians on discharge planning and care transitions
Process back-office discharges, including early discharges due to insurance requirements, and maintain scheduling calendars accordingly
Order patient supplies and maintain stock room inventory
Prepare and manage car stock for newly hired clinical staff
Add and maintain new physician records within company systems
Handle incoming clinical calls from patients, families, physicians, and other healthcare providers
Conduct patient visits as needed to support care coordination and patient outcomes
Enter hold orders and resume-of-care (ROC) orders
Coordinate referrals to outside providers, including Palliative Care and Wound Management Specialists
Follow up on laboratory results and communicate findings as appropriate
Review wound documentation, including photographs and measurements, for accuracy and completeness
Monitor hospital transfer admissions and discharge statuses daily to ensure continuity of care
Coordinate and order durable medical equipment (DME) for patients
Maintain accurate and timely documentation within the electronic medical record (EMR) system
Support interdisciplinary collaboration to ensure quality patient care and regulatory compliance