Registered Nurse; RN

Job Description Summary

At Health at Home, we believe in People Helping People—and our nurses are at the heart of that mission. As a Registered Nurse (RN), you’ll bring compassionate, skilled care directly into the homes of our patients. You’ll plan, organize, and direct home care services while making a true difference in the lives of individuals and families. Beyond bedside care, you’ll be an educator, advocate, and trusted resource—empowering patients and their loved ones to live healthier, safer, and more fulfilling lives in the comfort of home.

• Deliver Skilled Assessments:
  Complete OASIS assessments and data collection with accuracy and compassion, tailoring each evaluation to meet the patient’s unique needs. Perform thorough physical assessments and review medical history to establish baseline health status.
• Complete Evaluations Promptly & Design Individualized Plans:
  • Upon acceptance, respond to referrals quickly, scheduling and completing evaluations within agency time frames.
  • Identify nursing needs and risks, then develop individualized plans of care aligned with physician orders, patient goals, and evidence‑based standards.
  • Establish clear, measurable goals (short‑ and long‑term) with defined time frames.
• Provide Skilled Nursing Care:
  Deliver treatments and interventions such as wound care, medication management, IV therapy, and chronic disease management in accordance with the care plan. Adjust and update the plan as patient condition or physician orders change.
• Educate and Empower:
  Teach patients and families about disease management, medications, diet, and self‑care strategies. Provide ongoing coaching to build patient and caregiver confidence in managing health at home.
• Coordinate with the Care Team:
  Communicate consistently with the patient’s physician and interdisciplinary team to ensure care is cohesive and responsive. Act as Case Manager when assigned, ensuring smooth coordination of all services.
• Document with Excellence:
  Complete OASIS and visit documentation accurately, thoroughly, and within required time frames. Ensure all records meet regulatory, agency, and professional standards.
• Identify Additional Needs:
  Recognize when patients and families may benefit from additional services (PT, OT, SLP, MSW, HHA) and initiate referrals as appropriate.
• Engage in Team
  
  Collaboration:
  
  Participate in team conferences, in‑services, and staff meetings to strengthen communication and patient outcomes.
• Maintain Clinical Expertise:
  Stay current in nursing best practices, Medicare regulations, and home health standards through continuing education.
• Support Aide Supervision:
  Provide oversight, guidance, and evaluation of Home Health Aides per‑state and federal guidelines. When assigned as primary nurse, ensure aide care is consistent with the patient’s individualized plan of care.
• Contribute to Quality Improvement:
  Actively participate in performance improvement initiatives and quality assurance projects to support Health at Home’s 5‑star standards.

• Education & Licensure:
  Graduate of an accredited nursing program (Associate’s or Bachelor’s degree in Nursing required; BSN preferred). Holds an active, unencumbered Registered Nurse (RN) license in the state of practice, and in any additional states as required by agency operations.
• Certifications:
  
  Maintains current CPR certification through a Health at Home–approved provider. Additional specialty certifications (e.g., WOCN, IV Therapy) are welcomed and encouraged.
• Experience:
  
  Minimum of one (1) year of recent clinical nursing experience in a hospital, community health, or home health setting. Prior OASIS and home health experience strongly preferred but not required—training provided.
• Clinical Competence:
  Demonstrates ability to perform comprehensive patient assessments, develop and implement individualized care plans, and deliver skilled nursing interventions in accordance with best practices, physician orders, and regulatory standards.
• Communication &
  
  Collaboration:
  
  Strong interpersonal, written, and verbal communication skills with the ability to educate patients/families, work independently, and…