Home Care RN Case Manager

Location: MMH-8 Keynote Drive (10628)

Job Title: Home Health Nurse

Work where every moment matters. Over 40,000 Hartford Health Care colleagues dedicate themselves daily to provide pride in what they do. The Greater Manchester Region, serving 300,000 people in 19 towns, includes Manchester Memorial Hospital (249 beds), Rockville General (102 beds), a large multispecialty provider group, and visiting nurse services.

The provision of intermittent nursing service to patients in their homes under a plan of care established in collaboration with the patient’s physician and according to agency policies and procedures.

• Supervision Received:
  Reports directly to a Clinical Manager.
• Supervision Exercised:
  Home Care Aides.

Graduate of an NLN-approved school of nursing, participate in a baccalaureate or associate’s degree program.

One (1) year of recent medical/surgical nursing experience, additional experience in community health nursing preferred.

Current license to practice as a Registered Nurse in the State of Connecticut.

Full range of body motion including handling and lifting patients, manual and finger dexterity, eye‑hand coordination; standing, walking, ascending/descending stairs; operation of a motor vehicle; occasional lifting up to 30 pounds; corrected vision and hearing to normal range; working under stressful conditions; exposure to communicable diseases and/or bodily fluids.

Work performed in patients’ homes and in an office environment. Some exposure to communicable diseases, toxic substances, and medicinal preparations.

• Knowledge of professional nursing theory, practice, agency policies, regulations, and procedures.
• Knowledge of medical equipment and safety hazards to establish a safe work environment.
• Skill in applying and modifying nursing principles to provide ongoing patient care.
• Skill in identifying patient‑related problems and recommending solutions.
• Skill in documentation in clinical records.
• Skill in establishing and maintaining effective working relationships with patients, families, physicians, co‑workers, and the community.
• Ability to maintain quality control standards, react calmly and effectively in emergencies, interpret guidelines and procedures, and communicate clearly.
• Possess adequate transportation; must show proof of satisfactory automobile insurance with State of CT minimum coverage (recommended $100,000/300,000).
• Willingness to provide service in any part of Agency geographic area, according to Agency need.

• Admit/readmit patients and provide intermittent nursing service in compliance with agency policies and State/Federal regulations.
• Complete a comprehensive physical and psychosocial assessment.
• Develop and implement an appropriate care plan and therapeutic goals with the patient/family.
• Evaluate patient safety on a 24‑hour basis.
• Exercise clinical judgment in coordination of patient care by all involved services.
• Ongoing evaluation of significant changes in patient condition and progress toward therapeutic goals.
• Use agency and community consultants/resources.
• Instruction of patient/family in procedures, responsibilities, and optimum wellness practices.
• Plan for the patient’s discharge from service.
• Maintain case mix weight, utilization, and patient satisfaction aligning with industry standards and agency operational objectives.
• Document OASIS correlating with the Plan of Care; use recommended OASIS assessment techniques 100 % of the time.
• Export documentation, including activities and mileage, within 36 hours of visit or prior to next scheduled visit.
• Obtain physician verbal/written orders and comply with all reporting requirements.
• Participate in coordination of care with physicians and other disciplines as appropriate.
• Manage work assignments efficiently:
• Visit new therapeutic clients within 24 hours of referral unless otherwise specified by the physician.
• Report any cases to the Supervisor of Clinical Services that cannot meet goals or pose at‑risk situations.
• Remain flexible in daily planning for emergencies or unexpected visits.
• Maintain…