Job description

Job Title/Position: Registered Nurse Case Manager (RN)

Reports To: Clinical Supervisor or DPCS

Job Description Summary

The Registered Nurse case manager plans, organizes and directs home care services and is experienced in nursing, with emphasis on community, family health education/experience. The professional RN Case Manager builds from the resources of the medical community to plan and direct services to safely meet the needs of individuals and families within their homes and communities.

Essential Job Functions/Responsibilities

Patient Care

1. Completes an initial comprehensive assessment of patient and family to determine home care needs. Provides a complete physical assessment including review of current and previous diagnosis illness(es), and medication.

2. Regularly re-evaluates patient nursing needs every visit.

3. Develops the plan of care and makes necessary revisions as patient status and needs change with every visit and MD visit.

4. Uses health assessment data to determine nursing diagnosis.

5. Develops a care plan, which establishes goals based on nursing diagnosis and incorporates therapeutic, preventive, and rehabilitative nursing actions. Includes the patient and the family in the planning process.

6. Initiates appropriate preventive and rehabilitative nursing procedures. Administers medications and treatments as prescribed by the physician. Provides direct patient care as defined in the California State Nurse Practice Act.

7. Counsels the patient and family in meeting nursing and related needs.

8. Provides Home Health care and nursing instructions to the patient as appropriate per assessment plan of care and MD orders.

9. Identifies discharge planning needs as part of the care plan development and implements prior to discharge of the patient.

10. Performs as RN Case Manager when assigned by the DPCS or Clinical Supervisor and assumes responsibility to coordinate patient care for assigned caseload per MD signed plan of treatment.

Job Title/Position: Registered Nurse (RN)
Communication

1. Prepares clinical notes and MD orders and updates the primary physician when necessary and at least every 60 days when re-certification is completed.

2. Communicates with the physician regarding the patient’s needs and reports any changes in the patient’s condition; obtains/receives physician’s orders as required.

3. Communicates with community health related persons and home health team to coordinate the care plan.

Additional Duties
1. Participates in on-call duties as defined by the on-call policy.

2. Ensures that arrangements for equipment and other necessary items and services are provided and MD orders for equipment.

3. RN case manager instructs, supervises and evaluates home health aide care provided every two (2) weeks.

4. Participates in case conferences with Home Health team.

Position Qualifications

1. Graduate of an accredited school of nursing. One (1) to two (2) years of recent acute care experience in an institutional setting.

2. Current licensure in California and CPR certification (ACLS preferred).

3. Bachelor’s degree, with one (1) year of home health care experience preferred.

4. Management experience not required. Responsible for supervising home health aides.

5. Excellent observation, verbal and written communication skills, problem solving skills, basic math skills; nursing skills per competency checklist. Able to coordinate care with physicians and Home Health Team with documentation.

6. Prolonged or considerable walking or standing. Able to lift, position or transfer patients. Able to lift supplies and equipment. Considerable reaching, stooping, bending, kneeling or crouching. Visual acuity and hearing to perform required nursing skills.

7. Licensed driver with automobile that is in good working order and insured in accordance with the organization requirements.

Job Types: Full-time, Contract

Pay: $75,000.00 - $95,000.00 per year

Benefits:

• 401(k)
• Health insurance

Medical specialties:

• Home Health
• Wound Care

Standard shift:

• Day shift

Supplemental schedule:

• Holidays
• On call
• Overtime

Weekly schedule:

• Monday to Friday
• Weekend availability

Ability to commute/relocate:

• San Luis Obispo, CA: Reliably commute or planning to relocate before starting work (Preferred)

Experience:

• Home health: 1 year (Preferred)

License/Certification:

• RN License (Preferred)
• LVN License (Preferred)

Work Location: Multiple Locations

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