RN Case Manager- Home Health
Core
Manages nursing care and provides individualized care for patients of all ages in home health settings, including hospice care.
Role type
Registered Nurse Case Manager (Home Health)
Builds
Individualized care plans and patient outcomes
Domain
Home Health / Hospice Care
Deliverable
physical/clinical work
Required skills
Delegation, critical thinking, care assessment, care planning, care implementation, care evaluation, patient advocacy, care coordination, resource management, clinical expertise, problem-solving, prioritization, documentation, electronic medical record systems, growth and development knowledge, hospice care concepts
Preferred skills
Supervision of LPNs and Home Health Aides, performance improvement participation, orientation of new employees
Technologies
Electronic medical record systems, electronic devices
Responsibilities
Assesses, plans, implements, and evaluates patient care to achieve optimum outcomes. Completes and documents age-specific admission and ongoing assessments. Collaborates with the healthcare team, patient, and family to develop interdisciplinary plans of care. Administers and documents treatments and medications. Ensures patient care orders are current and effective. Identifies and documents patient and caregiver education needs. Promotes patient safety and positive outcomes during transitions of care. Serves as a patient advocate supporting psychological, social, and cultural needs. Plans strategies to prevent avoidable rehospitalizations. Manages resources and establishes priorities. Supervises LPNs and Home Health Aides. Maintains accurate case management documentation. Ensures visit frequencies reflect provider orders. Coordinates hospice patient and family care. Performs skilled visits including OASIS and recertification visits.
Seniority
Entry-level, hands-on IC