RN - Complete Care Program - Home Health Case Manager

Location Address:

Compensation Pay Range:

Minimum Offer $:

Maximum Offer for this position is up to $:

Summary:

How you grow, learn and thrive matters here.

• Educational and career development options, including tuition and certification reimbursement, scholarship opportunities

• Staff Safety (a wearable badge that allows nurses to quickly and discreetly call for help when safety is a concern)

• Differentials for night/weekend shifts, higher education, certifications and various lead roles (for eligible positions)

• Malpractice liability insurance

• Loan forgiveness through the New Mexico Higher Education Department

• EPIC electronic charting system

Type of Opportunity:

FTE:

Job Exempt:

Work Shift:

Responsibilities:

Sign on and relocation assistance available to qualified Candidates!

• In this role with our Hospital at Home Department, you will be responsible for case management of Home Healthcare patients.

• Ensures that care delivery is within quality and utilization guidelines and is directed toward the achievement of desired clinical outcomes for the disease state.

• Responsible for development, coordination and scheduling delivery of care through a multidisciplinary team to the patient in the home or community setting.

• The Case Manager assures completeness, timeliness and appropriateness of the patient care plan, its implementation and ongoing evaluation.

• Assures communication with the multidisciplinary team, support services and community resources to ensure that care goals are achieved in the most efficient and cost effective manner possible.

• Ensures that documentation is timely, accurate, complete and reimbursable. Is a patient advocate.

• Precepts newly hired nurses.

• PRN staff will not be responsible for managing a caseload; but all staff are required to manage the case load, follow up and communication for their daily assignments

• Demonstrates nursing care management of patients as evidence by

• a. Assessments that are complete, timely, and appropriate of physical, mental, psychological/social (behavioral), functional, financial, treatment, resource and spiritual needs of patients.

• b. Analysis that defines problems that are capable of correction through home healthcare and hospice interventions and are prioritized in development of care plan.

• c. Intervenes consistently with orders and changes interventions with orders to meet changes in patient need

• d. Evaluates each visit the effectiveness of interventions and the patients response to intervention.

• Provide direct patient care by assessing patient for care needs, resources to meet needs and developing a home care or hospice plan of care in conjunction with physician. Assures completion of required OASIS assessments according to regulations for home care and QAPI measures for hospice .

• Coordinates implementation of the plan of care through a multidisciplinary home care or hospice team, community resources and the physician

• Ensures plan of care is followed and that documentation complies with regulation.

• Maintains a department productivity standard for visits and caseload management.

• Demonstrates professional accountability for self-scheduling patient case load with appropriate frequency and duration, and concurrently updates schedule throughout the day as needed so that ongoing patient needs can be met.

• Assure patients on case load are notified timely of their visits and of any unplanned schedule changes accommodating, when possible, patent preferences for time of day.

• Precepts newly hired nurses, and students and serves as a resource person and professional role model as needed.

• Maintain communication with the multidisciplinary team s and assures that orders for necessary care plan changes are obtained and assures that changes are communicated timely to the team.

• Initiates documentation in the home and completely records all care delivery so that receiving staff have record of care delivered by the end of each day which includes admissions.

• Demonstrates proficiency and competency in interventions…