RN - Complete Care Program Home Health Case Manager

Location Address:

Compensation Pay Range:

Minimum Offer $:

Maximum Offer for this position is up to $:

Summary:

Sign on and relocation bonuses available for qualified candidates.

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:

Job Description:

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…