RN - Case Manager

Registered Nurse Case Manager

Develop and revise treatment and discharge plans in collaboration with the patient, family, physician, care delivery team, and third-party payors. Complete and submit OASIS assessments, reassessments, transfers, resumptions of care, discharges, and significant change in condition in accordance with defined time frames. Process orders and notify the physician of patient needs and changes in condition. Complete certification/recertification orders and discharge summaries.

Provide an environment that promotes respect for patients, their privacy, confidentiality, and property. Initiate appropriate preventive and rehabilitative strategies. Provide services requiring substantial specialized nursing skills. Consult with and educate patients, families, and other team members regarding disease processes, self-care techniques, and preventive strategies. Provide supervision of LPNs to ensure patient health, safety, and compliance with the plan of care.

Direct, coordinate, evaluate, and supervise the quality of patient care services. Interact with patients, physicians, referral sources, and others in a manner that promotes positive relationships. Support care management philosophy, including collaborative planning and case management designed to meet individual health needs. Ensure completion of all appropriate clinical records needed for compliance with legislation and delivery of seamless service. Maintain current knowledge of available community-based services.

Demonstrate flexibility and willingness to visit patients based on need. Ensure problem resolution at the point of contact. Ensure authorization and release of information forms are signed by patients or responsible parties. Attend patient care conferences for assigned patients. Monitor results and progress, taking corrective action on quality indicators and customer satisfaction. Understand the impact of the RN function on patients and other care providers.

Participate in efforts to reduce avoidable costs and errors. Respond to findings from Quality Management reviews/audits, ensuring resolution of potential problems. Participate in peer review and quality assessment and performance improvement activities. Maintain productivity requirements. Ensure that appropriate visit authorizations are in place and that visit documentation reflects the medical necessity for care in the home setting. Promote recognition, respect, and celebration of diversity in the workforce.

Participate in education, orientation, and self-development. Demonstrate commitment to professional growth and competency. Be responsible for the key performance indicators established by the manager. Perform other duties as requested.