RN Team Leader

Manages and coordinates team functions and performance to ensure appropriate home care services from admission to discharge, for assigned patients. Plans and coordinates the delivery of each assigned patient’s plan of care in accordance with physician orders. Plans, renders, and evaluates hands on care provided to each assigned patient. Supervises and teaches team members, including RN’s, LPN’s and HHA’s in the efficient and effective delivery of quality patient care in accordance with agency policies and procedures and physician’s orders.

Performs HCHB functions, in order to improve the clinical, operational and financial success of the agency.

• Registered Professional Nurse, currently licensed in the state of Tennessee.
• Minimum two years of home health experience.
• Working knowledge of the home health care program with previous management/supervisory experienced preferred.
• Previous experience scheduling home health visits preferred.
• Must be able to provide direct patient care and take on-call.
• Must be able to travel – trips vary in length and may require overnight stay.
• Computer data entry and word processing skills desirable.

• Assists with calls or inquiries from any referral source (hospitals, physicians, patients/family members etc.) and provides accurate and reliable information regarding the requirements for admission to home health care.
• Assists with the solicitation of necessary patient specific information (name, address, phone, insurance, diagnosis, services required, physician etc.) at the time of referral in order to coordinate care needs and schedule a timely admission visit.
• Obtains required billing information and coordinates prior approval to obtain pre-certification authorization including any co-payments or deductibles the patient is responsible for on admission, when indicated.
• Conducts initial admission visits and assures that services are initiated in a timely manner as ordered by the physician. Completes supporting documentation in an accurate and timely manner, including but not limited to; referral form, consent/service agreement, OASIS, 485 initial plan of treatment, care plan/plan of care, medication profile, progress note, personal care, care plan, etc.
• Establishes and maintains effective and efficient primary care teams and assigns each patient to a visiting nurse and monitors subsequent visits according to the plan of care.
• Coordinates referrals for Special Disciplines (PT, OT, ST, MSS) and assures timely initial evaluation visits and subsequent visits according to the plan of care.
• Assigns, develops, supervises, and evaluates nursing services provided by the RN’s and LPN’s, in accordance with the plan of care, organizational policies, procedures, processes, and applicable regulations.
• Assigns, develops, supervises, and evaluates personal care services provided by the home health aide in accordance with organizational policies, procedures, processes and Medicare/State regulations. Develops and revises, when indicated, the personal care, care plan for each patient receiving home health aide visits.
• Provides frequent communication to physicians, visiting staff members and others in efforts to coordinate changes in patient care and assures appropriate follow-up and supporting documentation is done.
• Coordinates requests/referrals for oxygen, medical equipment, pharmacy needs, community services, etc. according to patient need and physician order.
• Assures coordination of care with physicians, labs, in-patient facilities, etc. providing relevant information in a timely manner ( lab results, transfer/discharge info, status reports, etc.). Monitors patient’s inpatient status on a frequent basis and coordinates home health resume care…