Description

A Registered Nurse who is responsible for planning, coordinating, providing and documenting care for a geographically assigned caseload of patients from day of admission through day of discharge.  Utilizing physicians’ orders and professional skills, the Case Manager RN develops and implements a home health plan that meets each patient’s specific needs and is in compliance with accrediting organization standards, federal and state regulations, reimbursement guidelines as well as HHA policies and procedures.

QUALIFICATIONS

• Graduate from an accredited School of Nursing

• Current licensure in the State of Texas with renewal as required by law

• Possess a valid Texas Driver’s license, reliable automobile and proof of liability insurance.

• Experience as an RN commensurate with one of the following:

• One (1) year acute care experience within the last two (2) years;

• One (1) year home healthcare experience within the last two (2) years;

• One (1) year community health or public health experience within the last two (2) years;

• One (1) year outpatient facility experience within the last two years;

• Credentials in specialty area, i.e., phlebotomy, IV, ET.

• Current CPR card.

• Current health certificate/physical examination and TB testing.

• Full command of verbal and written communication skills.

• Demonstrated leadership capabilities with the ability to relate well to staff and other professionals.

Requirements

ROLE AND RESPONSIBILITIES

Performs admission assessment within 48 hours of referral or patient’s return to his/her residence.

• Develops a written plan of care for each patient in the assigned geographic caseload.

• Collects accurate OASIS data at time appropriate periods.

• Assesses patient’s condition, initiates plan of care, re-evaluates and updates as necessary.

• Ability to adequately assess and reassess pain.  Utilizes appropriate pain management techniques.  Educates the patient and family regarding pain management.

• Performs patient care responsibilities considering needs specific to the standard of care for patient’s age.

• Demonstrates knowledge of medications and their correct administration based on age of the patient and patient’s clinical position.

• Follows the seven (7) medication rights and reduces the potential for medication errors.

• Provides skilled nursing care.

• Obtains all necessary physician orders and collaborates with physician as patient’s needs dictate.

• Performs all aspects of patient care in an environment that optimizes patient safety and reduces the likelihood of medical/health care errors.

• Supports and maintains a culture of safety and quality.

• Participates in case conferences to discuss multidisciplinary team responsibilities, patient progress, plans for continued care, new problems, etc.

• Notifies the Intake Coordinator of patients who need to be seen on weekends or holidays and submits updated report weekend/holiday nurse.

• Follows up with obtaining lab results and notifying physician of any significant results.

• Re-evaluates the need for continued care on an ongoing basis; initiates recertification as necessary.

• Provides oversight to HHA LPN/LVN staff and co-signs documentation as needed in accordance with scope of practice.

• Plans for discharge from the HHA with the patient and family.  Makes referrals for alternative level of care if necessary.

• Addresses and supports cultural practices, as long as such practices do not harm others or interfere with the planned course of medical therapy.

• Promotes patient/family education using various verbal and written communication techniques that take into account the patient’s/family’s cultural, ethnic and/or personal needs or preferences.

• Supervises Home Health Aides on care given at a minimum of once every 14 days and as needed.

• Initiates needed referrals to other disciplines and/or community resources.

• Obtains needed supplies and equipment to provide care.

• Knowledgeable of current federal, state and HHA regulations concerning patient care.

• Participates in HHA’s other mandated activities, i.e., in-services, UR/PI committee, staff meetings.

• Adheres to all HHA, payroll, billing and documentation policies and procedures.

REQUIREMENTS 

• Support CMH’s mission, vision, core values and customer service philosophy

• Adhere to the CMH Compliance Program

• Assures/maintains compliance with all accreditation, statutory and regulatory standards at the local, state, and federal levels      

• Comply with all organizational policies 

• Maintain current clinical certification(s) and competencies required to support clinical staff

• Demonstrate outstanding customer service/advocacy, professionalism and integrity

• Adjust work hours/schedule to meet the needs of the department and hospital.

• Aware of all Emergency Disaster Plans and how to respond if a Disaster occurs.

• Works effectively with others, demonstrates leadership and teaching ability and the ability to work under pressure.

• Perform other duties as assigned 

KNOWLEDGE, SKILLS AND ABILITIES

• Comprehensive knowledge of general nursing theory and practice

• Strong organizational and interpersonal skills including the ability to communicate effectively, both orally and in writing

• Strong reasoning/clinical decision making skills

• Excellent time management, collaboration, prioritization and problem-solving skills

• Proficiency with computer skills including Microsoft Office applications and electronic health records systems

• Willingness to adapt to change and support new technologies as well as policies and procedures in a positive manner

• Ability to exercise initiative and independent judgment

• Ability to work with individuals, to enlist cooperation of many people to perform/achieve a common goal

PHYSICAL REQUIREMENTS AND ENVIRONMENTAL CONDITIONS

• Irregular hours

• Ability to participate in physical activity

• Ability to work for extended period of time while standing and being involved in physical activity

• Moderate lifting

• Position requires reaching, bending, stooping, and handling objects with hands and/or fingers, talking and/or hearing, and seeing

SUPERVISES:  Home Health & Hospice Aides

Salary : $27 - $43