RN CASE MANAGER

Registered Nurse The Registered Nurse is a Licensed Nurse who supervises staff nurses, coordinators, and other professional and paraprofessional staff as indicated. Qualifications • Graduate of an approved school of Nursing • Registered Nurse in the state(s) of service delivery • Minimum of two (2) years of experience as a Professional Nurse in home health care setting Responsibilities Ensure that nursing services are managed in accordance with the following: (Unless a physician orders therapy services only, a licensed nurse shall conduct patient assessments as follows) • The initial assessment is conducted within 72 hours of a patient's acceptance into a home health program and shall include a review of advance directives; • Reassessment is conducted within 60-day periods thereafter, according to the patient's needs and as the patient's condition warrants The assessments shall include: • Patient needs, resources, family, and environment • Goals of patient care • Medications used by the patient, including the side effects and contraindications • A listing of required medical supplies and durable medical goods. Registered Nurse is also responsible for the following: • Implementing a patient's plan of care Coordinating patient care with other members of the home health care team • Assigning a licensed practical nurse to provide nursing services in accordance with home health agency policies • Supervising home health aides and assigning written patient care duties to individual home health aides • Informing the patient's physician of changes in a patient's condition and needs • Summarizing the patient's status for submission to the physician, every 62 days or more often, as the patient's condition warrants • Ensuring that the findings and ongoing services are documented in the medical record for each patient contact • Participating in the preparation of patient transfer, discharge plan, and discharge summary • Documenting verbal orders received from the physician in the medical record • Conducting supervisory visits to the patient who is receiving home health aide services to determine the quality of care being given by the home health aide, according to the following schedule:  Every two weeks when home health aide services together with either nursing services or therapy services are being provided  Every 60 days while only home health aide services are being provided • Evaluating the performance, the competency of the home health aide and personal care attendant. Ensure that the home health aide services are provided under the supervision of a registered nurse as follows: • Home health aide services is provided by an individual who has completed a home health aide training • Perform only those tasks assigned, in writing, by the registered nurse or a therapist • Report any observations of change in a patient's condition to the registered nurse • Document care provided in the patient's medical record. Ensure that providers of therapy and other professional services comply with the following: • The services are ordered by a physician and provided in accordance with the patient's plan of care. • Assist the physician in evaluating the patient's needs • Participate in developing, evaluating, and revising the plan of care and establishing goals • Coordinate patient care with other members of the home health care team. • Ensure that the findings and ongoing services are documented in the medical record; and • Participate in the preparation of the patient transfer, discharge plan, and discharge summary. • A therapist or provider of professional services shall document any physician orders received pertaining to their respective therapy or professional services. • A therapist may supervise a home health aide when a physician orders home health aide and therapy services only. As a supervisor, the therapist shall: • Assign patient care duties, in writing, to the home health aide • Comply with the assessment require