RN Case Manager- Home Health

Carilion Clinic•Hardy, VA

11d•$34 - $50

About The Position

The RN Case Manager, Home Health and Hospice manages nursing care and provides individualized care for patients of all ages. The role uses delegation, critical thinking, and a collaborative, team-oriented approach to deliver quality patient care. The nurse assesses, plans, implements, and evaluates care to achieve optimum patient outcomes, completing age-specific admission and ongoing assessments and using them to develop and update the plan of care. This is a weekend-schedule position, with an orientation period Monday through Friday before transitioning to weekends. Company equipment and mileage reimbursement are provided. The role manages all aspects of assigned patient care, including case conferences and care coordination; performs skilled visits, including OASIS and recertification visits, as needed; and coordinates home health and hospice services in collaboration with patients, families, providers, and interdisciplinary teams. Care includes work in a variety of settings and support for terminally ill patients and their families. The position requires a graduate of an accredited Registered Nurse program and an active RN license in Virginia or an approved compact state. A valid driver’s license, automobile insurance, and personal vehicle are required for home visits. Compensation is listed as $33.52–$50.28; employee pay depends on qualifications, credentials, education, and prior work experience.

Requirements

Graduate of an accredited Registered Nurse program.
Currently licensed as a Registered Nurse in Virginia or an approved compact state.
Valid driver’s license, automobile insurance, and personal vehicle for making home visits.
Keyboarding skills for automated computer systems, including electronic medical records.
Knowledge of principles of life-span growth and development and ability to assess data reflective of a patient’s status.
Ability to interpret information needed to identify age-specific patient requirements and provide care according to departmental policies and procedures.
Advanced patient-care knowledge and skills.
Strong critical-thinking skills, including the ability to interpret laws and regulations related to CHCS and Carilion Clinic.
Ability to prioritize work in a fast-paced patient-care environment.

Responsibilities

Manage nursing care and provide individualized care for patients of all ages.
Assess, plan, implement, and evaluate patient care to achieve optimum outcomes.
Complete and document age-specific admission and ongoing assessments and use them to develop the plan of care.
Collaborate with the health care team, patient, and family to develop, implement, and revise the interdisciplinary plan of care.
Administer and document treatments and medications using electronic medical record systems.
Ensure patient care orders are current, accurate, implemented, and evaluated for effectiveness.
Identify, implement, and document patient and caregiver education needs.
Promote patient safety, patient-centered care, and positive outcomes during transitions of care.
Serve as a patient advocate and support patients’ psychological, social, and cultural needs.
Apply knowledge of growth and development to care for assigned patients.
Use clinical expertise in rapidly changing circumstances.
Plan strategies to prevent avoidable rehospitalizations, reduce resource use, and improve patient outcomes.
Manage resources, establish priorities, and seek supervisory direction as needed.
Use problem-solving skills to resolve patient care and staff issues.
Participate in performance improvement activities and assigned projects.
Assist with orientation of new employees and serve as a clinical role model.
Manage assigned patient care, including case conferences and care coordination.
Supervise LPNs and Home Health Aides as required by regulatory guidelines.
Maintain accurate and current case management documentation.
Ensure visit frequencies reflect provider orders and evidence-based practice.
Collaborate with scheduling, billing, and other departments to support care coordination, authorization, and communication of patient financial obligations.
Perform skilled visits, including OASIS and recertification visits, as needed.
Coordinate required forms, including BIPA, ABN, HHABN, or other forms required by CMS or agency policy.
Securely use electronic devices to access, transfer, and synchronize information to support communication and continuity of care.
Coordinate hospice patient and family care with the hospice interdisciplinary team, Medical Director, and attending physician.
Apply understanding of hospice care concepts and issues related to caring for terminally ill patients.
Provide competent, compassionate care in a variety of settings and comply with hospice policies and procedures.
Participate in special hospice events, such as grief camps and memorial services.