Rn-Case Mgr - Full-time / Part-time

ATLANTIC CASS CO HOME CARE

FTE: 1.000000

ESSENTIAL FUNCTIONS AND RESPONSIBILITIES :

The Case Manager coordinates and delivers patient care to ensure the achievement of patient outcomes and ensure patient satisfaction with the care received.

The Case Manager performs the following duties:

Assumes accountability for assessing, coordinating and implementing care and services using tele-monitoring for all appropriate patients as assigned:

Accurately completes OASIS assessment information and develops patient care plans with five days of the admission visit.

Places a tele-monitor in the patients home at the time of admission.

Incorporates the use of tele-monitoring into the home care patient clinical assessment, care plan development and patient care.

Reviews the OASIS documentation and care plan with the Clinical supervisor/Supervisor as requested.

Attends case conferences as requested.

Maintains a high level of productivity performing the majority of necessary in-home visits for patients on their census and performs and documents a minimum of one telephone visit on each monitored patient weekly.

Care manages an average of 25 to 30 patients.

Performs SOC visits, post-hospital evaluations, patient re-certifications, discharges and supervisory visits within the work base as assigned.

Implements clinical protocols during the admission visit as dictated by patients diagnosis (as appropriate). Reports vital sign alerts and subtle changes in vital sign trends to the physician according to protocol in a timely manner. Initiates additional physician orders as needed and implements appropriate interventions. Provides thorough instruction and disease management education to patients and/or caregivers as ordered by the physician. Educates patients, families, and caregivers about disease process and recommended self care. Ensures that all patients and/or their caregivers understand their rights and responsibilities. Formulates and updates Home Health Aide care plans as appropriate and performs supervisory visits for Home Health Aides every fourteen days. Performs on-call duties and weekend/after hour visits on a rotational basis as assigned. Completes all documentation accurately and submits to office within 24 hours of visit, phone call and/or change in treatment or orders.

Reviews and follows up on lab work in a timely manner and documents follow up activities.

Maintains a current medication list in the patient record.

Reviews medication list for drug interactions and contraindications and notifies the physician of any identified interactions or contraindications.

Participates in clinical record audits, quality monitoring activities and patient outcome improvement initiatives.

Coordinates the patient care plan with all disciplines.

Communicates care plan updates to clinical supervisor on each patient, every 14 days.

Promotes the services of UnityPoint at Home internally and externally.

Ensures organizational sustainability through the efficient use of corporate resources.

GENERAL DUTIES

Attends and participates in in-service training programs, team conferences and other workshops as assigned.

Maintains current knowledge base and nursing skills through continuing education activities and/or in-service classes.

Follows agency policies and procedures when performing job duties.

Maintain regular and consistent attendance at work.

Behave in a manner consistent with Mission, Vision, Values and Expectations for Excellence.

Maintain compliance with OSHA, Accreditation Standards and Risk Management guidelines.

Maintain compliance with Personnel policies and procedures.

Behave in a manner consistent with all Corporate Compliance policies and procedures.

Meets measures as determined and required for job productivity and performance improvement.

Achieve certification in Integrated Care Management within 1 year of hire. Certification includes completing the Integrated Care Management formal training session, successfully completing assigned computer based-learning modules within 2 weeks of training, and a competency evaluation. Use the Integrated Care Management philosophy, skills, tools and documentation in clinical practice. Demonstrate competency in selected ICM skills annually.

Employee is responsible for completion of communication tasks and activities in a timely manner. This would include, but is not limited to: responding to email, voicemail or telephony messages, promptly, accurately, and professionally; attending staff meetings as scheduled or viewing videotapes of those meetings; asking questions of team members and supervisors when needing clarification about various day-to-day issues or patient needs; and reviewing employee communication pieces, to stay aware of UnityPoint at Home programs and initiatives.

Perform other duties as requested by the Clinical supervisor.

SUPERVISION RECEIVED :

From Clinical Supervisor

QUALIFICATIONS REQUIRED :

Graduate of State Board approved program for Registered Nurses.

Current license to practice nursing according to the state where service is provided.

CPR: Maintain a valid Basic Life Support (BLS) Healthcare Provider Card with Re-certification.

Strong interpersonal skills.

Ability to work as a collaborative team member.

Ability to understand and apply guidelines, policies and procedures.

Strong computer skills.

Valid licensed driver with automobile insurance in accordance with state and/or organizational requirements.

QUALIFICATIONS PREFERRED:

Masters education in health related field.

BSN or BS in health related field.

PICC line and Chemotherapy certification

Previous home care experience.

EOE M/F/V/D