Care Manager RN

Care Manager RN
- Community Care
- Hall, Barrow, Forsyth, North Gwinnett Lead with compassion. Manage with purpose. Who are we?

Caring for Atlanta for over 78 years, Visiting Nurse Health System is a leading, non-profit provider of home healthcare, long-term care at home, hospice, and palliative care services. We pride ourselves in helping patients and their loved ones receive care at home following an illness, surgery, or hospital stay. We offer not just a job, but we also offer purpose, impact, and the chance to care deeply for people in the comfort of their homes.

Our vision is to be the first choice for patients, families, payers, and other healthcare providers when they need home healthcare services. We look to not only achieve, but to also maintain exemplary patient and employee satisfaction levels. VNHS is dedicated to continuing our investment in strong community partnerships, providing coordinated care solutions, developing a top-performing workforce, and innovating technologies to improve affordability and access to patient care.

We aim to be an organization where healthcare professionals not only prefer to work, but where they are able to grow as professionals. For more information on our organization, please visit us here.

Every day we strive to display our four core values:

• Respect & Integrity - We practice the highest ethical standards and honor our commitments. We are fair, transparent, honest and person-centered in all our actions. We value the beliefs and opinions of our diverse community of patients and employees.
• Excellence - We are committed to delivering the best outcomes and highest quality service through the dedicated efforts of every team member. We are committed to continuous improvement in all that we do and strive to be leaders for others to emulate.
• Stewardship - We enhance the lives of those we serve through responsible planning and management of the resources entrusted to us with each of us contributing toward a shared purpose.
• Care - We will provide compassionate person-centered care while respecting individual physical, emotional, and spiritual needs

The Care Manager RN plays a key role in assessing, coordinating, and monitoring community-based services for elderly or disabled clients under the Community Care Services Program (CCSP). This role includes conducting home visits, reassessing care needs, developing plans of care, and collaborating with physicians, social workers, and caregivers to ensure continuity of care.

Conduct in-home or facility-based assessments of clients to determine appropriate services.

Collaborate with SW Care Managers and interdisciplinary teams on level-of-care (LOC) decisions.

Develop care paths and discharge plans based on client needs, condition, and support systems.

Complete and document assessment tools (e.g., GDS, MMSE, fall risk).

Schedule and perform timely assessments, reassessments, and follow-up per DCH policy.

Coordinate transitions from hospital to home/community settings.

Document care plans, hospitalizations, care transitions, services, and case notes per DCH and VNHS standards.

Approve services within established funding limits and ensure clinical appropriateness.

Participate in interdisciplinary team meetings, training sessions, and quarterly network events.

Support infection control practices and maintain confidential client records.

PRN

Are a graduate of an accredited RN program

Hold current Georgia licensure and CPR certification

Have 2 years of nursing experience in community health, long-term care, or geriatrics

Understand Medicare/Medicaid regulations and care coordination best practices

Can function independently in a community-based environment

Possess strong clinical, documentation, and time management skills

Are comfortable with EMR systems and standard office software

Have reliable transportation and are comfortable traveling to client homes

• Medical, Dental, and Vision insurance
• PTO and Paid Holidays
• 403b Retirement Plan with Company Match
• Flexible Spending Account (FSA)
• Health Savings Account (HSA)
• Life Insurance
• E…