RN Case Manager - Registered Nurse

Signature Healthcare at Home - Home Health is seeking a compassionate and experienced (preferred) RN case manager for the East side of Portland/PDX area. The Registered Nurse plans, organizes and directs home health care and is experienced in nursing, with emphasis on community health education/experience. The professional nurse builds from the resources ofthe community to plan and direct services to meet the needs of individuals and families within their homes and communities.

Pay: $56+ depending on experience.

• Completes an initial, comprehensive and ongoing comprehensive assessment of patient andfamily/caregiver living situation to determine care needs. Provides a complete physical assessment and history of current and previous illness(es).
• Provides professional nursing care by utilizing all elements of nursing process and as defined in thestate Nurse Practice Act.
• Assesses and evaluates patient’s status by:
  
  Establishing the initial individualized plan of care in collaboration with the certifying medical provider based on comprehensive assessment and patient goals.
  
  Regularly re-evaluating patient and family/caregiver needs.
  
  Participating in revising the plan of care as necessary in collaboration with the certifyingmedical provider as patient status and needs change.
• Develops a care plan that establishes interventions and goals. Includes the patient and thefamily/caregiver in the planning process.
• Works autonomously to initiate appropriate preventive and rehabilitative nursing procedures.
  
  Administers medications and treatments as prescribed by the medical provider in the plan of care.
• Involves the patient and family/caregiver to address needs and meet related goals.
• Provides health care instructions to the patient as appropriate per assessment and plan.
• Facilitates the patient’s efforts toward self-sufficiency or obtaining appropriate caregiving.
• Acts as Case Manager when assigned by Clinical Manager and assumes responsibility to coordinate patient care for assigned caseload.

• Documents patient services and status timely and accurately within professional practice standard sand reimbursement requirements.
• Records pain/symptom management changes/outcomes as appropriate.
• Communicates with the medical provider regarding the patient’s needs and reports changes in the patient’s condition; obtains/receives medical provider orders as required.
• Teaches the patient and family/caregiver self-care techniques as appropriate. Provides medication,diet and other instructions as ordered by the medical provider and recognizes and utilizesopportunities for health counseling with patients and families/caregivers. Works in concert with the interdisciplinary team.
• Assists the patient and family/caregiver and other team members in providing continuity of care.
• Attends required staff meetings, interdisciplinary team meetings and care coordination activities.

• Participates in on-call duties as defined by the on-call policy.
• Ensures that arrangements for equipment and other necessary items and services are available.
• Supervises ancillary personnel and delegates responsibilities when required.
• Coordinates patient care in tandem with LPN/LVN as assigned by Clinical Manager.
• Assumes responsibility for personal growth and development and maintains and upgrades professional knowledge and practice skills through attendance and participation in continuing education and in-service classes.
• Fulfills the obligation of requested and/or accepted case assignments.
• Actively participates in quality assessment performance improvement teams and activities or othercommittees as assigned.
• May be required to work outside of designated geographical area based on census fluctuations and current staffing.
• Completes mandatory education requirements annually to maintain competence.
• May be required to visit patients in homes that are not clean, or in poor repair, have poor ventilation,are infested with insects or rodents, and secondhand smoke.
• Driving conditions may be difficult related to weather and/ or traffic.
• Maintains knowledge of and adheres to all applicable laws, rules, and standards.
• Participates in the orientation of new employees and preceptorship of students as assigned.
• Meets productivity expectations.

The above statements are intended to be a representative summary of the major duties and responsibilities performed by incumbents of this job. The incumbents may be requested to perform…